HEALTHPLANUSA . NET
Community For Affordable Health Care
Vol VI, No 1, April, 2007
Utilizing the $1.4 Trillion Information Technology Industry
To Transform the $1.8 Trillion HealthCare Industry into Affordable HealthCare
In This Issue:
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Rebate financing for medical care, By Philip Booth, Associate Dean, City University Business School
It is a common belief that tax funding is the only way to guarantee good healthcare for all. And yet statistics show that, after 50 years of just such a policy, our National Health Service (NHS) actually delivers for UK citizens one of the poorest-quality health systems in the developed world. Like other tax-funded industries of the postwar era, it is burdened by bureaucracy, politicisation, [sic] low wages, a lack of customer responsiveness, low rates of innovation, queuing, and mis-directed resources.
But recent initiatives to deal with these problems, though sincere, have tried to work within today’s tax-funding model, instead of asking whether that system itself should be reformed or even replaced. The Wanless report, for example, did not explore how the funding base could be widened nor whether fair access could be preserved through some other method. It did not separate provision from funding, nor funding from access. In line with this, current reform strategies have been top-down, centralized attempts to control and set targets within a closed system, rather than to open up the system to new methods of funding, and greater customer power.
The majority of people believe that the NHS has certain desirable attributes. But it is unlikely to be able to build on them unless the power to control moves away from politicians and officials to those who use and rely upon its services. There is a simple way to achieve this: a rebate. The cost of NHS care should be defined, and given back to citizens for them to decide how to spend as they think best. That will give them the power to obtain the kind of service they want, rather than the kind selected for them by the providers.
To work well, the rebate must be simple. It must be a set amount, which people can take and put towards the cost of company or individual health and long-term care plans. People should be free to add their own money to buy more expensive policies if they choose to, or to pocket the difference if they can find a qualifying plan more cheaply. It would be larger for women and elderly people, reflecting their greater cost to the NHS; but not people’s personal health status: there would be no medical. But those who wanted to stay in the state system could do so. Indeed, if the rebate were slightly below the real cost of NHS the care foregone by the leavers, the NHS would actually retain more money to focus on the needs of those who stay.
Coupled with liberalising reforms in the way NHS services are managed and provided, the rebate would give everyone at least some incentive to take responsibility for their own health and the opportunity to access the kind of quality health service they are currently denied.
To read the entire lengthy article, please go to www.adamsmith.org/health/index.php/publications/details/getting_back_your_health/.
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2. In the News: Health Insurance Folly, By GRACE-MARIE TURNER, WSJ, March 17, 2007
The Wall Street Journal published a commentary that Grace-Marie wrote for them on the folly of expanding SCHIP and the need to bring more private sector options into the program.
Senate Democratic leaders this week unveiled plans to dramatically expand taxpayer-funded health insurance to millions more children through the State Children's Health Insurance Program -- even as 14 states are running out of money to fund coverage for children in the program now.
Eighteen governors have blamed the White House for shortchanging the program in its budget by $10 to $15 billion. But SCHIP isn't in peril because of Washington's tight purse strings. Many of the governors themselves have led the program astray.
Launched in 1997, SCHIP provides health insurance to more than six million enrollees, primarily children in lower-income families. Originally authorized to spend $40 billion over 10 years, the program is set to expire this year unless Congress approves new funding.
Senate Budget Chairman Kent Conrad this week said his plan would expand coverage to 8.3 million more uninsured children and boost spending by $50 billion over the next five years. Both Republicans and Democrats support SCHIP's reauthorization, and President Bush called for its renewal in his recent budget proposal. But one reason SCHIP is in trouble is because it has allowed states to provide taxpayer-subsidized health care for adults and middle-income families, even when poor children go without coverage.
That's right. Despite the program's name, a number of states use SCHIP dollars to cover adults at the expense of poor children. And most of the states that are running out of SCHIP money are those that cover adults in their programs. In 2005, for example, 87% of Minnesota's SCHIP enrollees were adults, as were 66% of those enrolled in Wisconsin's program. In Arizona -- which has one of the highest rates of uninsured children in the nation -- 56% of those enrolled in SCHIP were adults. All have their hands out to Washington for more money.
SCHIP funds are also used, often, to insure children who are not in low-income families. In New Jersey, for example, SCHIP covers children whose parents earn up to three-and-a-half times the poverty line -- an amount that exceeds $72,000 a year. Sen. Hillary Clinton and Rep. John Dingell announced this week their own bill that would subsidize coverage for kids in families earning up to four times the poverty level -- or nearly $83,000 for a family of four.
States misuse their SCHIP dollars because the program is structurally flawed. The federal government gives states more money for those enrolled in SCHIP than for those covered by Medicaid, which is designed to provide health coverage to low-income Americans. A simple expansion of SCHIP does not address this flaw. . .
So what should be done? First, adults should not be eligible for SCHIP. Covering adults was never the intent of the program, and states that extend coverage to adults are diverting funds from the needs of low-income children. Second, SCHIP should focus on America's poorest families. When the program was created, congressional leaders explicitly stated that the program should assist only families who earn up to twice the poverty line. States need to meet the law's intent.
Finally, it must be easier for states to utilize SCHIP as a premium-support program. It is relatively inexpensive to add children to family policies, but by making the process so bureaucratic, employer-provided plans are underutilized and families are split into private and public coverage plans.
Congress has a chance to bring some needed discipline to the program and in doing so, ensure that it fulfills SCHIP 's core purpose of covering kids first.
Ms. Turner is president of the Galen Institute. www.galen.org
To read the entire article, go to http://online.wsj.com/article_print/SB117408653808140017.html. (Subscription is required.)
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Private docs can set own fees as SMA drops guidelines, By Lim Wei Chean, the Singapore Straits-Times, April 3, 2007
PRIVATE doctors here are free to set their own fees from now, instead of referring to guidelines drawn up by the Singapore Medical Association (SMA).
The SMA agreed to withdraw the guidelines during its annual general meeting on Sunday after receiving word that the guide could be in contravention of the recently- enacted competition code.
SMA President Wong Chiang Yin told The Straits Times yesterday that it would be contacting its 4,800 members this week to alert them to the surprise change.
It is not known how the move will affect the fees doctors charge, but Dr Wong suggested that doctors refrain from making 'drastic changes in the short-term' to avoid worrying patients and escalating health-care costs.
To help patients make fee comparisons, he added that the SMA will survey private doctors on their fees and publish the results online.
The fee guide, started in 1987 for both general practitioners (GPs) and specialists, was intended to inject some transparency into private medical charges.
It was mooted by the Government to prevent cases of rampant overcharging. It said it would legislate fees if the medical fraternity did not take things in hand.
In response, the SMA came out with a guide giving a range of charges for various services, including what doctors can charge on weekends and public holidays, and even for issuing a death certificate. . .
However, since the Competition Act was enacted last year, the SMA has been grappling with the legality of the guidelines.
It consulted its lawyers and was told the guidelines could be illegal.
However, the SMA had several misgivings about withdrawing them. One concern was whether patients with small claims would have an avenue for redress if the guidelines were withdrawn,
Dr Wong also argued that patients, especially those who need specialist treatment, are not like other consumers who 'shop around' for better value for money.
The association then decided to write to the Competition Commission for clarification.
However, the commission reiterated a section of the Act stating that 'recommendations of a trade association in relation to price...may be considered to be price-fixing, regardless of the form it takes'.
When contacted yesterday, the chairman of the Government Parliamentary Committee for Health Halimah Yacob expressed dismay at the change and said: 'Health care is an important public good that should be exempted from the competition code. . .
But the executive director of the Consumer's Association of Singapore Seah Seng Choon felt that the withdrawal is 'good in principle as it endorses the concept of free competition'.
He said doctors should display their fees clearly in their clinics so patients know the charges before they decide to seek treatment. . . .
The Health Ministry told The Straits Times yesterday that under its guidelines for private hospitals and medical clinics, doctors are encouraged to publish their consultation charges before seeing patients.
A separate law under the Private Hospitals and Medical Clinics Regulations also requires hospital managers to inform patients before or on admission the estimated total charges for their stay.
It said it will continue to publish pricing data and historical price trends on its website.
Government Medicine does not give timely access to healthcare, it only gives access to a waiting list.
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4. Medicare: Negotiated Drug Prices May Not Lower Costs, by Alain Enthoven and Kyna Fong
Rep. Nancy Pelosi has promised that within its first 100 hours the Democrat-controlled House will repeal the ban preventing Medicare from negotiating directly with pharmaceutical companies. She must expect this legislation to bring down drug prices dramatically. However, it is not obvious that allowing the government to negotiate with pharmaceutical companies will lead to lower prices than those achieved by private drug plans. There are several good reasons why not.
Market Power versus Bargaining Power. Negotiations are a bargaining process. The relative balance of bargaining power determines at which price the deal is struck.
People often confuse market power with bargaining power. The thinking goes, the larger the share of the market the buyer represents, the greater the bargaining power and thus the lower the prices negotiated. That line of reasoning fails with drugs, however, because the seller is frequently a monopolist with an exclusive patent. That means the seller cannot be threatened with replacement by a substitute. Instead, the only threat is that the two sides fail to agree and the drug is withheld from the market.
Rather than market share, a party’s bargaining power is determined simply by the ability to say no — to walk away from the table without an agreement. Whether the government or a private drug plan has greater bargaining power is not clear. Who can walk away more easily and declare some brand-name drug will not be covered on the formulary? Private plans like Kaiser Permanente or UnitedHealth Group are able to negotiate deep discounts with pharmaceutical companies precisely because of the plans’ ability to say no — to pay for some drugs and to exclude others, allowing the market to judge the resulting formulary. But when the government negotiates, there are few drugs it can exclude without facing political backlash from doctors and the Medicare voters.
Price Discounts. If the government acts as one large buyer for Medicare, the cost to pharmaceutical companies of granting discounts becomes greater. As a result, drug companies are not able to offer discounts to the government as large as they have previously offered to some individual plans. When individual private drug plans are negotiating with pharmaceutical companies, those companies have the power to “price discriminate,” charging lower prices to some plans and higher prices to others. This ability makes large discounts possible for some plans. Government consolidation of demand into one entity that is given a single discount is similar to forcing all discounts to all drug plans to be the same. Other things equal, this leads to higher, not lower, prices.
Medicaid Discounts. Experience with Medicaid shows what can happen when one buyer’s price discount is linked to the discounts of other buyers. Medicaid’s best-price rule states roughly that Medicaid will be granted the lowest price offered to any drug buyer. If that price is not low enough, Medicaid receives a fixed discount off the average price. In effect, the best-price rule transforms all privately negotiated discounts into public discounts for Medicaid.
Research by academics, along with a slew of anecdotal press reports, suggests that since the passage of the Medicaid best-price rule in 1990, prices paid by the private sector have risen. According to research by Yale University economist Fiona S. Morton, the best-price rule has had a small but noticeable effect on the prescription drug prices paid by non-Medicaid purchasers:
■ Prices paid by the public for brand-name drugs with generic competitors have increased an average of more than 4 percent. [See Figure I.]
■ Price increases have been highest for drugs for which Medicaid purchases comprise a larger share of sales.
■ Drug discounts to non-Medicaid buyers have fallen.
■ Manufacturers have also compensated for the lower prices granted to Medicaid by changing product mix and pricing strategy (for instance, by reducing per-unit price breaks on larger drug packages).
By the end of the first year under the best-price rule, federal, state and local governments saved an estimated $150 million per quarter in Medicaid expenditures. But given the resulting price increases for non-Medicaid buyers — including other government drug purchasers, such as the Veterans’ Administration (VA) — the savings to society are not at all clear.
Restricting Access to Drugs. What about the argument that government negotiations lead to lower prices in Canada, Britain and other countries? While those governments may obtain lower prices than the public pays in the United States, the real question is the following: Do those governments negotiate lower prices than what would be negotiated if smaller groups of buyers were able to deal individually with pharmaceutical companies?
In other countries health care systems also lower their drug bills by controlling entry and restricting formularies. But with the expansion of the Internet and unrestrained information flow, patients are challenging these restrictions. A well-publicized legal battle by a woman against a British National Health Service (NHS) decision not to cover Herceptin for early-stage breast cancer has compelled the NHS to reverse its original decision and offer coverage for that drug.
In the United States, the VA’s tight control over drug costs is often cited as a model for Medicare to follow. However, it is important to recognize that the main tool the VA employs to control drug costs is restricting the set of drugs that are covered. As a result, less than one-third of the drugs available to Medicare patients are available to VA patients. [See Figure II.]
Government Interference. Finally, one may consider the possibility that, rather than have the market determine prices, perhaps the government can do better by setting reimbursement levels itself. But how can the government determine what prices appropriately reimburse pharmaceutical companies for their research and development efforts? How can the government determine what prices will encourage the right levels of future innovation?
Government interference and negotiations inevitably encourage private parties to try to influence the process through political lobbying and campaign contributions — activities at which pharmaceutical companies have proven quite adept.
Conclusion. Congressional Democrats need to be careful in trying to make the logical leap from market share to bargaining power. Empowering the government to negotiate with pharmaceutical companies is not necessarily equivalent to achieving lower drug prices. In fact, neither economic theory nor historical experience suggests that will be the outcome.
Alain Enthoven is a professor emeritus at the Graduate School of Business at Stanford University, where Kyna Fong is a doctoral student in economics. A version of this article previously appeared in The Wall Street Journal.
To read the entire article, please go to http://cdhc.ncpa.org/.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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5. Lean HealthCare: Lessons from Jim Womack, Chairman, Lean Enterprise Institute
Health Care has so many out of control requirements placed on it by government, hospitals, insurance carriers and non-medical controlled HMOs that the very people that are capable of thinking about improvement, have no time to be innovative. It’s time to throw off the shackles placed on our profession that increases the cost of our services and decreases their value.
Our final hypothesis is that most managers have learned to see muda (waste) in the individual steps of their value streams. But they fail to see, much less to tackle, the problems of mura (unevenness) and muri (overburden) that create much of the muda. For example, we routinely see managers with so many out-of-control conditions to work around that they have no time left over for thinking about improvement. They are proud of how hard they work and what they manage to achieve in chaotic conditions. Yet the press of the exceptional—the thing “gone wrong”—crowds out the pressing need for true problem solving. As a result few problems ever get solved.
Where does this muri come from? Usually it is created within the organization rather than externally by the customer, as most managers seem to believe. Actions by managers in one part of the organization cause unevenness (mura) in the activities of managers and employees in other parts of the organization. And this causes muri – the overburden most managers feel most of the time. . . It follows that to make real progress in organizational transformation managers need to address all three Ms – muda, mura, and muri – at the same time.
As I said at the outset, these are simply hypotheses. We’ll inform everyone of our findings. But in the meantime I hope you will devise your own hypotheses about the most effective methods for lean transformation and put them to the test. And I hope you will be willing to share your findings with the Lean Community around the world.
Best regards, Jim Womack, Chairman and Founder, Lean Enterprise Institute
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NEW YORK: You don’t have to read very far into the papers, or go to the doctor much, to find that the American health care system is on the precipice of disaster, with costs rising, ever more uninsured people, and high numbers of deaths due to errors or complications - 98,000 of them a year, according to a widely cited estimate by the Institute of Medicine of the National Academy of Sciences.
We spend twice as much ($6,000 a year a year for every man, woman and child) and have worse results than some European countries. [Be sure to see the featured article from the UK in section 1.]
Costs are going up three times as fast as inflation, which means that fewer companies can afford to buy health insurance for their employees, which means in turn that more and more people are uninsured. [Being uninsured is a product of health care being laid on backs of employers. It has to be given back to the employees for innovation and cost control.]
Contrary to the view of many outside this country - that millions of Americans get no care at all - the uninsured do get treated, paying some of the bills out of pocket, or not paying at all. But the unpaid expenses are then passed along in the form of higher costs, leading to more people who can’t get insurance, and on and on. . . [Getting on a waiting list for years amounts to no care at all since many die on such waiting lists.]
Not surprisingly, as a result, even a Republican president like George W. Bush is talking about health care reform, and so are the Democratic presidential candidates. Under the circumstances, it seemed that a small personal story about a colonoscopy might have some bearing.
A colonoscopy is a routine check for colon cancer that people over 50 are supposed to have every five years so that any polyps or other growths can be removed before they have become harmful and vastly more expensive to treat. In the spirit of smart preventive medicine, I went a few weeks ago to my doctor to have the procedure done.
All went well, as it usually does in the higher echelons of American medicine, where doctors are top-notch and the treatment delivered in immaculate conditions. There is something new in the universe of colonoscopies, moreover, at least in my doctor’s office: the procedure there is now done under anesthesia, so the considerable, if momentary, discomfort that it used to cause has been eliminated.
And my medical insurance - paid for by my employer - covered the entire cost. [Therein lies the problem. If Bernstein had to pay for this diagnostic study, he would have researched the medical need and probably foregone the colonoscopy since many American Gastroenterologists feel the procedure is vastly over rated and overdone.]
Still there is that cost and it was high: the insurance company statements showed that the anesthesiologist charged, and was paid, $1,400 for the half-hour procedure. The internist who actually performed the colonoscopy sent a bill for $1,000, but accepted the insurance company’s payment of $800. [In my community there is no anesthesiologist present. . . If Mr Bernstein were involved in paying for the colonoscopy, even if only 20 percent of the cost, he would make sure these huge fees would be unacceptable. Only in our current socialized bureaucracy in America can this exist. It would not be tolerated if we were in a private or free-market environment.]
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There is a continuing debate on Capital Hill by one party about pulling troops out of Iraq and using the money to take over the US Health Care Program. The other party is pointing out that there has been a monthly average of 160,000 troops in the Iraq theatre of operations during the last 22 months, and a total of 2,112 deaths. That gives a firearm death rate of 60 per 100,000 soldiers.
The firearm death rate in Washington D.C. is 80.6 per 100,000 persons for the same period. So the opposition is pointing out that you are about 33% more likely to be shot and killed in the U.S. Capital than you are in Iraq. They are suggesting a different conclusion:
The U.S. should pull out of Washington.
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Sara is 29 years old. She has a 33-year-old sister, a mother and a maternal aunt who all died of breast cancer. There is a high likelihood that she has a genetic form of breast cancer.
The good news, if there is any, is that if Sara has a genetic predisposition for breast cancer, there are steps she might want to take to decrease the chance it will cause her death. Some of these interventions are dramatic, including the removal of both breasts before they develop cancer.
Of course, she wouldn't want to take these steps if she doesn't have a genetic predisposition. But Sara is stuck. She works in a small business, and if she gets tested and the result is positive, she can be denied health and life insurance coverage for the rest of her life. Insurance companies argue that the presence of the gene should be considered a "pre-existing condition" even though Sara is, and has always been, extremely healthy.
It appears Congress will again consider a bill to prevent discrimination against those with, or at risk for, a genetic condition. This will be the seventh time the issue has come before Congress.
The Genetic Information Nondiscrimination Act would make it illegal for the insurance industry to deny a healthy woman such as Sara insurance, or for employers to deny her employment based solely on genetic test results. The past seven times, the bill failed in one chamber or the other, opposed by Republican leaders. At least for now, the bill seems to have bipartisan and public support. Opposition comes from the U.S. Chamber of Commerce. It says the bill imposes too large a burden on employers.
If we had a national health insurance plan, this wouldn't be an issue. * In addition to the myriad other benefits that would come from a national health plan, not having to worry about insurance discrimination would make conducting genetic research far easier and a benefit to all Americans.
There are 1,300 genetic tests used today to identify genetic conditions, up from just 100 tests five years ago. Genetic testing will most certainly increase as we discover new links between specific genes and the diseases they cause.
Doctors often order these genetic tests without carefully discussing with their patients the ethical and social implications of a positive test. **
Admittedly, in many cases, I don't discuss the pros and cons of ordering a routine urine test or a complete blood count. My presumption is that when a patient comes to the doctor, he wants to be involved in significant decisions, but not at the level of ordinary diagnostic tests.
Genetic testing is different. While the test itself involves a simple blood draw, and the doctor may wish to order the test for a medically sound reason, the social implications need to be carefully discussed with the patient. In these discussions, I have seen some women like Sara decide against testing for fear the result will fall into the wrong hands. I have seen other women not give the decision a second thought: "Of course I want to know if I carry a cancer gene. Why are you asking me?"
As we discover more about genetics, I suspect most of us will end up with some sort of genetic predisposition to illness. Carried to an extreme, isn't life itself a predisposition to death?
To read the full article, please go to www.sacbee.com/107/v-print/story/142542.html.
[* Others would argue that if the government-funded health care and thus genetic testing, the results would essentially be in a national data registry controlled by HIPAA regulations. This would allow most government agencies access, including tens of millions of employees. But doctors and those that need to know in order to take care of these very patients have difficulty in accessing this information. Genetic testing can only be kept confidential in a private healthcare system where each doctor protects the medical information, including test results of all of his/her patients.]
[** In our experience, private doctors discuss the ethical and social implications of a positive test with their patients much more thoroughly than government or bureaucratic doctors and understand the importance of keeping this information out of the insurance data registry.]
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One of the large issues in the privatization of health care is insurability. Having the worker own his own insurance plan and taking it with him will keep him/her insured. But is there a better way?
Our research group is trying to obtain data on using a health-risk model instead of a disease model. In other words, a patient with diabetes is essentially uninsurable. Likewise, a patient with cancer or arteriosclerotic heart disease post a myocardial infarction. But can we obtain the necessary premiums from those who are increasing their risk for heart disease, or cancer or diabetes through personal habits? Why should the person who tries to live a healthy life pay premiums to insure those that smoke, drink excessively, eat morbidly or live a risky lifestyle? The risk of these self-induced diseases can be calculated and the premiums adjusted accordingly.
For example, one who smokes two packs a day will easily double his health-care costs because of bronchitis, emphysema and lung cancer. Why shouldn’t he pay twice the premium of the nonsmoker? Those who have congenital emphysema without any cigarette history would then obtain insurance under the standard premium.
The person who has a body mass index of 40 will have twice (estimated) the health-care costs of a person with a BMI of 20. Shouldn’t that be reflected in the premium before they get the complications of obesity rather than when they acquire diabetes, etc?
Such a premium structure would have the salutary benefit of decreasing cigarette consumption or over-eating more than any cigarette withdrawal clinic or weight-loss program.
If there is any support for such a program, we would love to hear from you.
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10. Restoring Accountability in Medical Practice by Non Participation in Government Programs and Understanding the Devastating Force Of Government.
· Lew Rockwell's premier free-market site can be found at www.lewrockwell.com. Be sure to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see www.lewrockwell.com/rockwell/sickness.html; or to find out why anyone would want to be an MD today, see www.lewrockwell.com/klassen/klassen46.html.
· PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/. Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law. Ever have a blinding migraine and couldn't even drive to see a doctor? Dr Huntoon even makes house calls. Canadian patients are welcomed. Such a deal.
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Articles that appear in MedicalTuesday and HPUSA may not reflect the opinion of the editorial staff. Sections 1-8 are entirely attributable quotes in the interest of the health care debate.
Editorial comments are in brackets.
ALSO NOTE: MedicalTuesday and HPUSA receive no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.
Del Meyer, MD, CEO & Founder
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Words of Wisdom
LABELS: No one is just one thing: The label that’s been given to them, the definition that one has accepted and lives within. Nonetheless, so much of what we work and live by seems based on these seemingly transparent assumptions. . . We must use social labels and self-defining names as they should be used, as convenient constructs to get a handle on the shifting world, to be replaced by more suitable ones as the world shifts again, as we shift again. –Philip Kan Gotanda, in the preface to No More Cherry Blossoms.
MANAGEMENT IS NO MORE A SCIENCE THAN IS MEDICINE: BOTH ARE PRACTICES. The modern enterprise is a human and social organization. Management as a discipline and as a practice deals with human and social values. To be sure, the organization exists for an end beyond itself. In the case of business enterprise, the end is economic; in the case of the hospital, it is the care of the patient and his or her recovery; in the case of the university, it is teaching, learning and research. To achieve these ends, the peculiar modern invention we call management organizes human beings for joint performance and creates social organization. But only when management succeeds in making the human resources of the organization productive is it able to attain the desired outside objectives and results.
Some Related Postings
THE BUSINESS OF MEDICINE by J K Silver, MD, www.delmeyer.net/bkrev_BusinessofMedicine.htm
www.healthplanusa.net/GrameenBank.htm Global Advances in Health Care
Aphorisms & Anecdotage
I care not who writes the nation’s laws, if I can write its songs.
Music is the international language because everybody responds to its notes.
The song is ended but the melody lingers on.
Let’s face the music.
Some of the strongest people in the world can’t carry a tune.
The orchestra played Tschaikowsky’s Romeo and Juliet overture, and the longhaired elderly man in the audience wept and wept. “You must be an incurable romantic,” said the lady next to him. “No,” he said, “I’m a musician.”
Hell is full of musical amateurs. Music is the brandy of the damned. GB Shaw, 1903