Community For Affordable Health Care

Vol IV, No 4, January, 2006


Utilizing the $1.4 Trillion Information Technology Industry

To Transform the $1.7 Trillion HealthCare Industry into Affordable HealthCare

In This Issue:                        

1.Featured Article: Would you want to live in a world reduced to hard facts? by Ken Myers

2.In the News: Let Your Own Epidermis Become a Medical MonitorFast Company

3.International Medicine: Access to New Medications Delayed In Europe – Galen Institute

4.Governmental Health Plans: Waiting for Surgery by Basil Peabody, London

5.Lean HealthCare: LEAN SOLUTIONS, a book by James P Womack and Daniel T Jones

6.Insurance Myths: People are uninsured because they can’t afford insurance.

7.Overheard on Capital Hill: Subsidies Help Farmers, Business, Medicine-Everyone - Reason

8.What's New in Health Care:  HealthPlan4Life by Steve Barchet

9.Health Plan USA: Where are we now? Ideal HealthPlan: Portability? HSA Revolution.

10.Doctors Restoring Accountability in Medical Practice by Non Participation in Insurance and Government Programs

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1.Feature Article: Would you want to live in a world reduced to hard facts? By Ken Myers, President, Mars Hill Audio

Twenty years ago, writing in The Wilson Quarterly, the literary critic Cleanth Brooks noted that: “A world reduced to hard facts would thereby become a dehumanized world, a world in which few of us would want to live. We are intensely interested in how our fellow human beings behave—in their actions, to be sure, but also in the feelings, motives, purposes that lead them into these actions.”

Most of us don’t believe in a world reduced to hard facts, but for some time, Western societies have found it virtually impossible to order public life around anything other than hard facts. The Canadian philosopher George Parkin Grant, in an essay written in the 1960s, commented on the widely held assumption in modern societies that the only knowledge that is properly considered objective and public is scientific knowledge, that is, knowledge of hard facts. Grant posed three questions that flowed from this assumption: “(a) whether there is any knowledge other than that reached by quantifying and experimental methods, (b) whether, as such methods cannot provide knowledge of the proper purposes of human life, the very idea of there being better and worse purposes has any sense to it, (c) whether, indeed, purpose is not merely what we will in power from the midst of chaos. The effect of these questionings on the humanities could not but be enormous.”

The work of Michael Polanyi is a valuable resource in combatting the assumptions about the unique worth of scientific knowledge. Polanyi, who lived from 1891 to 1976, was a scientist, an accomplished physical chemist, who turned to philosophy later in his life in order to address some of the social crises prompted by the misleading ideals of objectivity derived from science. Several years ago, MARS HILL AUDIO produced a lengthy audio documentary about Polanyi’s life and work, and one of the experts we interviewed was Dr. Martin X. Moleski. Now a new biography of Polanyi co-written by Moleski has just been published. The book is called simply, Michael Polanyi: Scientist and Philosopher . . .

Professor Martin X. Moleski explains why Michael Polanyi (1891-1976) left his career in science to become a philosopher . . . Polanyi was trained and worked as a scientist and physical chemist until he realized the totalitarian regimes of Europe were basing their destructive and dehumanizing view of humanity on a faulty definition of knowledge. Polanyi knew the definition was inadequate; he became a philosopher in order to study why. He dedicated himself, notes Moleski, to explicating a system of personal knowledge that considers the body important and attends to what knowing the world through the body entails. He also espoused the dignity of the person, the love of truth, and—among other goods—justice.

Ken Myers, President, Mars Hill Audio. To hear the entire dialogue, subscribe at To see the segment file and the gateway to this series, please go to

Central to Michael Polanyi's thinking was the belief that creative acts (especially acts of discovery) are shot-through or charged with strong personal feelings and commitments (hence the title of his most famous work Personal Knowledge). Arguing against the then dominant position that science was somehow value-free, Michael Polanyi sought to bring into creative tension a concern with reasoned and critical interrogation with other, more 'tacit', forms of knowing.

Polanyi's argument was that the informed guesses, hunches and imaginings that are part of exploratory acts are motivated by what he describes as 'passions'. They might well be aimed at discovering 'truth', but they are not necessarily in a form that can be stated in propositional or formal terms. As Michael Polanyi (1967: 4) wrote in The Tacit Dimension, we should start from the fact that 'we can know more than we can tell'. He termed this pre-logical phase of knowing as 'tacit knowledge'.  Tacit knowledge comprises a range of conceptual and sensory information and images that can be brought to bear in an attempt to make sense of something (see Hodgkin 1991). Many bits of tacit knowledge can be brought together to help form a new model or theory. This inevitably led him to explore connoisseurship and the process of discovery (rather than with the validation or refutation of theories and models - in contrast with Popper, for example).

We must conclude that the paradigmatic case of scientific knowledge, in which all faculties that are necessary for finding and holding scientific knowledge are fully developed, is the knowledge of approaching discovery.

To hold such knowledge is an act deeply committed to the conviction that there is something there to be discovered. It is personal, in the sense of involving the personality of him who holds it, and also in the sense of being, as a rule, solitary; but there is no trace in it of self-indulgence. The discoverer is filled with a compelling sense of responsibility for the pursuit of a hidden truth, which demands his services for revealing it. His act of knowing exercises a personal judgement in relating evidence to an external reality, an aspect of which he is seeking to apprehend. (Polanyi 1967: 24-5)

Michael Polanyi placed a strong emphasis on dialogue within an open community (a theme taken up later strongly by the physicist David Bohm). He recognized the strength by which we hold opinions and understandings and our resistance to changing them. Unlike many of his contemporaries he placed his thinking within an appreciation of God and of the power of worship - especially in his later writing (see, for example, Meaning). In his earlier work (especially in Personal Knowledge) Polanyi seems to be preoccupied with 'setting forth ways to think about religious meaning as an articulate system or framework related to other articulate systems' (Mullins undated). Later Michael Polanyi attempted to extend his model to describe the nature of human knowledge found in art, myth and religion. 


In respect of the philosophy of science, it can be argued that Michael Polanyi helped to pave the way for Thomas Kuhn's groundbreaking work on the structure of scientific revolutions. Perhaps the strongest echo of his work that we encounter as educators comes through the work of Donald Schön and Chris Argyris on knowing in action, and in Eisner's consistent arguments for connoisseurship and criticism in evaluation. It also has parallels in Jerome Bruner's (1960) distinction between mediated and immediate cognition or apprehension.

By paying attention to Polanyi's conception of the tacit dimension we can begin to make sense of the place of intuition and hunches in informal education practice - and how we can come a better understanding of what might be going on in different situations. Significantly, his attention to passions and commitments throws fresh light on the praxis (informed, committed actions) that stand at the heart of informal education.

To read more, go to

Reproduced from the encyclopaedia of informal education:

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2.In the News:  Let Your Own Epidermis Become a Medical Monitor

A new concept could let your own epidermis become a medical monitor. By: Joseph Manez, In Fast Company, January 2006 Page 35.

The future of health care? It may be this concept for programmable video displays embedded just under the surface of your epidermis, made possible by billions of microscopic robots.

Robert A. Freitas Jr., a fellow at the Institute for Molecular Manufacturing, says the robots, one-billionth of a meter small, would emit minuscule amounts of light. Together they could form text and graphics, recognizing finger-tap instructions to scroll and change menus. Other nanorobots throughout your body would gather medical data and transmit it to the display.

Dartmouth and MIT researchers have already built tiny, wirelessly controlled robots. Freitas says the machines he envisions, a thousandth the size of those critters, will take another 20 years to perfect. The goal, he says, is to empower people "to take control of their own personal medical destiny" with constantly updated data at their fingertips (and in them).

To read the entire article (Subscription required), go to

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3.  International Medicine: Access to New Medications Delayed in Europe

One of the hidden costs to patients of controlling prescription drug prices -- ostensibly to make them more "affordable" -- can be doing without new drug therapies. For many years, the U.S. Food & Drug Administration has been criticized for delaying final approval of new drugs' safety and effectiveness after the completion of clinical trials.

But in many European countries, after new drugs have been approved by the national ministries of health in each country or by the European Agency for the Evaluation of Medicines, patients must wait while drugs clear another hurdle.

This additional regulatory delay is a side effect of drug price controls. Before they can market a new medicine, pharmaceutical companies must obtain approval from each national government for the prices they charge. Then, in an often in a separate process, they must get approval of reimbursement rates without which the drugs are inaccessible to most patients.

As a result, access to breakthrough drugs is delayed sometimes four years or more in many European Union countries, according to two new studies by the London-based research organization, Europe Economics. For example,

  • Patients in Spain, Greece and Portugal waited nearly three years for access to a major new cardiovascular drug after it was available in other EU countries.
  • Patients were forced to wait more than four years in Greece and Portugal and for three years in Belgium and France before they could use a major new anti-infective therapy already available in other EU countries.
  • Patients who needed a major new nervous system medication were denied access for nearly six additional years in Portugal and three years in France.

In 1995, EU Members began a centralized, marketing authorization process intended to ensure "rapid access" to new medications. But centralized approval has not reduced delays in the pricing and reimbursement processes.

To read the entire article and sources, go to


Source: "In Europe, Access to New Medications Takes Time," September 28, 2000, Galen Institute, P.O. Box 19080, Alexandria, Va. 22320, (703) 299-8900; "Patient Access to Major Pharmaceutical Products in EU Member States," and "Patient Access to Pharmaceuticals Approved through Mutual Recognition," Europe Economics, Chancery House, 53-64 Chancery Lane, London, WC2A 1QU, United Kingdom, +44 (0)20 7831-4717.


For Galen text:

For more on International Health Care:

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4.Governmental Health Plans: Waiting for Surgery by Basil Peabody, London

Sir - Like Tony Blair, I, too, suffer from an irregular heartbeat (News, January 3). As a fit 37 year old, my condition has had a catastrophic impact on my life; while not being life threatening, it is lifestyle threatening.

I was released from Chelsea and Westminster Hospital into the care of the Brompton Hospital in July, where I was told that the waiting list for the procedure to cure it was one year. In desperation, I contacted all the major London hospitals known for performing this treatment and was told that the waiting list in each of them was a year, too. When I asked whether going privately would be any quicker, I was told by the Brompton that the procedure could be done 10 days later at a price of £8,000. This was echoed by the three other London hospitals I contacted.

On weighing up the pros and cons of the wait versus the loan, I decided to opt for the wait, despite the fact that the condition had reduced my exercise output from three gym visits a week to the odd slow set of stairs.

Thankfully, I managed to secure a slot for the procedure on the NHS after a modest six-month wait and am now recovering.

To be put in the position of having to decide whether to take a loan or suffer in silence is a quite farcical state of affairs for an apparently first world country with an allegedly exemplary medical service that is the envy of the world.

Read more:

It is absolutely beyond comprehension to think that what Mr. Peabody describes as the envy of the world would be considered as third-world medicine? Is there someway we can enlarge the horizons of the British?

Meanwhile, San Francisco is working overtime trying to get in the same box.

Working together on health care, Monday, January 30, 2006

WHILE Washington and Sacramento fiddle over health care, San Francisco wants to act. The city is considering a mandate that businesses with 20 or more workers offer coverage.

It’s a noble goal that comes loaded with potential benefits and drawbacks. Supervisor Tom Ammiano pushed forward the idea in November, but it contained a jaw-dropping price tag of $345 per month per employee that a business would have to pay.

Not surprisingly, the idea fueled outrage among employers. The standoff seemed headed to a winner-take-all ballot showdown between business and liberal-interest groups.

Ammiano, sensibly, is now calling for a timeout to negotiate. He’s dumping the original deluxe coverage for a cheaper model priced at $50 to $75 that he plans to debut Wednesday. This package aims at basic coverage, such as checkups and preventive care, for a population of 35,000 to 40,000 uninsured, who typically work in small shops and restaurants.

Ammiano has supplied other missing ingredients to clarify his plan. Employees who live outside the city wouldn’t be covered, and part-time workers would cost employers less. Spouses and partners covered by other health plans may be exempted. Firms that already pay for health care wouldn’t need to chip in more.

These changes may greatly reduce employer worries. “If this is a way to get everyone to put down their guns, then it’s positive,” said Chamber of Commerce CEO Steve Falk, who opposed the first version.

It’s a welcome fresh start, though plenty of questions remain. Ammiano, who plans to meet with Falk today, hopes he can craft a compromise within the next few months. He’s avoided the easy game of demonizing his critics and played down the nuclear option of taking his plans directly to voters. That’s the last place a detail-filled package should be decided.

There are still plenty of unanswered questions over the level of care, cost, eligibility and access. On a parallel track, Mayor Gavin Newsom is also speeding up a plan to use the city’s health clinics to offer coverage to a pool of uninsured residents, though the details are unclear.

With business, the mayor and Ammiano all advocating plans or ideas, it makes sense to pause and consider. The unknowns could be cleared up with a fuller study, not just deal-making among major players.

Ammiano and supporters of expanded health care think such a study will only delay their plan and isn’t needed. He favors passing the concept of basic health coverage with the details and price worked out later by a commission appointed by the mayor and Board of Supervisors.

Sorry, this isn’t good enough. If ever there was a complicated undertaking in need of thorough study, health care is it. Due-diligence homework shouldn’t penalize any side. Asking questions, interviewing experts and collecting data is not tantamount to killing a promising idea.

San Francisco voters, as Ammiano is fond of saying, have supported expanded health care in a string of ballot propositions and bond measures. The city’s largest department is public health, an indication of the city’s priorities, he suggests.

But these same voters also approved a rule in 2004 requiring economic analysis of board actions that impact the local economy, as this concept surely would. Small-business operators, who may be the chief targets of the health-care proposal, complain the extra costs will severely hamper operations or drive them out of town.

Right now, thousands of San Francisco residents are left out of the health-care system. A basic test, X-ray or doctor’s visit with a sick child remains out of reach.

The city needs to face an important challenge in caring for this populace, who hold down jobs without a key fringe benefit. Reaching them should be a top priority, and so should full knowledge of the costs and conditions that go with supplying health care.


Coverage for checkups and preventive care without hospital care is like having car insurance for oil changes and preventive maintenance but not collision. The former are not insurable items either on your car or your health. No wonder health care is in such a predicament.

There seems to be a lack of understanding of the basic concept of insurance.

Let’s join Jeff Daniels in singing, “If I weren’t so stupid, you wouldn’t be so smart.”

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1.Lean HealthCare: LEAN SOLUTIONS, a book by James P Womack and Daniel T Jones

How Companies And Customers Can Create Value And Wealth Together

[A Lesson for Health Care. Read this review thinking of health care providers as physicians and patients as consumers. The answers to our health care problems lie in Lean Thinking, Lean Consumption, Lean Solutions and Lean Provisions.]

A massive disconnect exists between consumers and providers today. Consumers have a greater selection of higher quality goods to choose from and can obtain these items from a growing number of sources. Computers, cars, and even big-box retail sites promise to solve our every need. So why aren’t consumers any happier? Because everything surrounding the process of obtaining and using all these products causes us frustration and disappointment. Why is it that, when our computers or our cell phones fail to satisfy our needs, virtually every interaction with help lines, support centers, or any organization providing service is marked with wasted time and extra hassle? And who among us hasn’t spent countless hours in the waiting room at the doctor’s office, or driven away from the mechanic only to have the “fix engine” light go on?

In their bestselling business classic Lean Thinking, James Womack and Daniel Jones introduced the world to the principles of lean production—principles for eliminating waste during production. Now, in Lean Solutions, the authors establish the groundbreaking principles of lean consumption, showing companies how to eliminate inefficiency during consumption.

The problem is neither that companies don’t care nor that the people trying to fix our broken products are inept. Rather, it’s that few companies today see consumption as a process—a series of linked goods and services, all of which must occur seamlessly for the consumer to be satisfied. Buying a home computer, for example, involves researching, purchasing, integrating, maintaining, upgrading, and, ultimately, replacing it.

In this landmark new book, James Womack and Daniel Jones deconstruct this broken producer-consumer model and show businesses how to repair it. Across all industries, companies that apply the principles of lean consumption will learn how to provide the full value consumers desire from products without wasting time or effort—theirs or the consumers’—and as a result these companies will be more profitable and competitive. . . .

From Lean Solutions
"Consumption should be easier and more satisfying due to better, cheaper products. Instead it requires growing time and hassle to get all of our goods and services to work properly and work together. And this seems very strange when we stop to consider that satisfying consumption is the whole point of lean production."

Womack and Jones address this issue by expanding their principles to the next logical area, staying true to the heart of lean. “As we grasped the situation, we realized that we needed to heed our principles of lean production by returning to the starting point, the question of value. We needed to ask what consumers really want in the era ahead. Then we needed to rethink consumption from first principles as a process—like production, but from the opposite direction—in order to discover a better way from consumers to obtain the goods and services they want now. We call this process lean consumption.

“Lean consumption must have a companion process. Companies must provide the goods and services consumers actually want, when and where they are wanted, without burdening the consumer. We’ve used the term ‘lean production’ in the past, but too many managers act as if production stops at the office door or the factory gate. So we now use the term lean provision, which comprises all of the steps required to deliver the desired value from producer to customer, often running through a number of organizations.

“Most of us find it easy to think about consumption when we are consumers and easy to think about provision when we are at work. But all of us find it difficult to see these interlocking processes together as a unified value stream. As we have walked through a range of industries in recent years, from airlines to healthcare to automotive repair services, we have repeatedly observed consumers and employees struggling valiantly with misaligned consumption and provision processes that alienate customers, drain away profits, and burden staff with feelings of rage and despair. Yet they soldier on in a fog of mutual incomprehension.

“As we continued our investigations—visiting many companies in many industries in many countries—we began to see that if truly lean provision can be married to truly lean consumption, life can be better for consumers, more satisfying for employees, and more profitable for providers. A win-win-win is possible in which providers, employees, and consumers create lean solutions together. This fundamental insight led directly to this book.”

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2.Insurance Myths: People are uninsured because they can’t afford insurance.

Characteristics of an Ideal Health Care System, by John C. Goodman, PhD, President, NCPA.

Executive Summary

Why should government be involved at all in our health care system? Aside from providing care for low-income families, the most persuasive argument is that in the absence of coercion people will have an incentive to be uninsured “free riders.” In our society, people who choose not to pay for insurance know that they are likely to get health care anyway — even if they can’t pay for it. The reason is that there is a tacit, widely shared agreement that no one will be allowed to go without care. As a result, the willfully uninsured impose external costs on others — through the higher taxes or higher prices which subsidize the cost of their care.

What evidence is there that free riders are a problem? One piece of evidence is the number of uninsured:

_ According to the Census Bureau, in 1999 there were 42.6 million people who were uninsured at any one time, a larger percentage of the population than a decade ago.

_ The rise in the number of uninsured has occurred during a time when per capita income and wealth, however measured, have been rising.

Although it is common to think of the uninsured as having low incomes, many families who lack insurance are solidly middle class. And the largest increase in the number of uninsured in recent years has occurred among higher-income families:

_ About one in seven uninsured persons lives in a family with an income between $50,000 and $75,000, and almost one in six earns more than $75,000.

_ Further, between 1993 and 1999, the bulk of the increase in the number of uninsured was among the households earning more than $50,000.

_ By contrast, in households earning less than $50,000 the number of uninsured decreased by about 5 percent.

In deciding to be uninsured by choice, many healthy individuals are undoubtedly responding to perverse incentives created by government policies.

_ On the one hand, we make an enormous amount of free care available to the uninsured; in Texas, for example, it totals $1,000 per uninsured person every year, on the average.

_ Also, federal and state laws are making it increasingly easy for people to obtain insurance after they get sick — thus removing the incentive to buy insurance when they are healthy.

_ Finally, although the federal government generously subsidizes employer-provided insurance, most of the uninsured are not eligible for an employer plan, and they get virtually no tax relief when they buy insurance on their own.

Far from solving the free rider problem, most government interventions these days are making the problem worse. Indeed, we might be better off under a policy of laissez faire.

If we accept the free rider argument, however, what policy implications logically follow from it?

One commonly proposed solution is to have government require people to purchase insurance. However, this is neither necessary nor sufficient. Instead, a complete solution would have 10 characteristics. Adhering to each of them would lead to a system that provides a reasonable form of universal coverage for everyone without adding to national health care spending and without intrusive and unenforceable government mandates.

To read the entire Executive Summary, please to go

Insurance Fact: Most People Are Uninsured By Choice

What To Consider When Making An Application For Health Insurance.  The Monetary Authority of Singapore

Your duty to provide information

An insurance contract is based on trust. When you apply for health insurance, you must provide all the information asked for. Such information would include your age and occupation, and any history of illnesses, medical conditions or disability.

If you do not provide important information when you apply for health insurance, the policy you take up may not actually cover you. If you are not sure whether certain information is important, you should still provide the details. This includes any information you may have given to the financial adviser or insurance intermediary but not included in your application.

Accepting your application

The insurer will assess the information you have given them, and decide whether or not to accept your application. If you are not in good health, the insurer may refuse to provide certain benefits, or increase the premium charged, or reject your application.

When you are in hospital

In Singapore, high-quality public and private healthcare is easily available. However, the cost of healthcare differs greatly between private and public hospitals, and between different types of ward.

So when you need to go into hospital you should:

• check the ward charges and the costs of medical treatment recommended by your doctor;

• check whether the benefits under your health insurance will cover all the costs;

• consider the options available to you; and

• choose your ward or treatment according to what you can afford.

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3.Overheard on Capital Hill: Subsidies Help Farmers, Business, Medicine-Everyone

Six Reasons to Kill Farm Subsidies and Trade Barriers - A no-nonsense reform strategy. In Reason,

By Daniel Griswold, Stephen Slivinski, Christopher Preble

America’s agricultural policies have remained fundamentally unchanged for nearly three-quarters of a century. The U.S. government continues to subsidize the production of rice, milk, sugar, cotton, peanuts, tobacco, and other commodities, while restricting imports to maintain artificially high domestic prices. The competition and innovation that have changed the face of the planet have been effectively locked out of America’s farm economy by politicians who fear farm voters more than the dispersed consumers who subsidize them.

The time is ripe for unilaterally removing those distorting trade policies. In 2006 Congress will begin to write a new farm bill to replace the protectionist and subsidy-laden 2002 legislation that is set to expire in 2007. Meanwhile, the Bush administration will be negotiating with 147 other members of the World Trade Organization to conclude the Doha Round before the president’s trade promotion authority expires in mid-2007. Congress and the administration should seize the opportunity to do ourselves a big favor by eliminating farm subsidies and trade barriers, a change that would benefit all Americans in six important ways.

1. Lower Food Prices for American Families

The foremost reason to curtail farm protectionism is to benefit American consumers. By shielding the domestic market from global competition, government farm programs raise the cost of food and with it the overall cost of living. According to the Organization for Economic Co-operation and Development, the higher domestic food prices caused by U.S. farm programs transferred $16.2 billion from American consumers to domestic agricultural producers in 2004. That amounts to an annual “food tax” per household of $146. This consumer tax is paid over and above what we dole out to farmers through the federal budget.

American consumers pay more than double the world price for sugar. The federal sugar program guarantees domestic producers a take of 22.9 cents per pound for beet sugar and 18 cents for cane sugar, while the world spot price for raw cane sugar is currently about 10 cents per pound. A 2000 study by the General Accounting Office estimated that Americans paid an extra $1.9 billion a year for sugar due to import quotas alone.

American families also pay more for their milk, butter, and cheese, thanks to federal dairy price supports and trade barriers. The federal government administers a byzantine system of domestic price supports, marketing orders, import controls, export subsidies, and domestic and international giveaway programs. According to the U.S. International Trade Commission, between 2000 and 2002 the average domestic price of nonfat dry milk was 23 percent higher than the world price, cheese 37 percent higher, and butter more than double. Trade policies also drive up prices for peanuts, cotton, beef, orange juice, canned tuna, and other products.

These costs are compounded by escalating tariffs based on the amount of processing embodied in a product. If the government allowed lower, market prices for commodity inputs, processed foods would be substantially cheaper. Lifting sugar protection, for example, would apply downward pressure on the prices we pay for candy, soft drinks, bakery goods, and other sugar-containing products.

The burden of higher domestic food costs falls disproportionately on poor households. Farm protections act as a regressive tax, with higher prices at the grocery store negating some or all of the income support the government seeks to deliver via programs such as food stamps.

If American farm subsidies and trade barriers were significantly reduced, millions of American households would enjoy higher real incomes.

2. Lower Costs and Increased Exports for American Companies

Producers who export goods to the rest of the world and manufacturers who use agricultural inputs would also stand to benefit significantly from farm reform. So would their employees.

When government intervention raises domestic prices for raw materials and other commodities, it imposes higher costs on “downstream” users in the supply chain. Those higher costs can mean higher prices for consumers, reduced global competitiveness for American exporters, lower sales, less investment, and ultimately fewer employment opportunities and lower pay in the affected industries. Artificially high commodity prices drive domestic producers abroad to seek cheaper inputs—or out of business altogether.

In the last two decades, the number of sugar refineries in the U.S. has dwindled from 23 to eight, largely because of the doubled price of domestic raw sugar. During the last decade thousands of jobs have been lost in the confectionary industry, with losses especially heavy in the Chicago area. Expensive food also hurts restaurants.

Enterprises outside the food business would benefit from farm reform as well. Rich countries’ agricultural trade barriers remain the single greatest obstacle to a comprehensive World Trade Organization (WTO) agreement on trade liberalization. The current round of talks, the Doha Development Round, came to a halt in Cancun in 2003 when the Group of 20 developing countries demanded more serious farm reform by the rich countries as an essential pre-condition. Any progress at the December 2005 meeting in Hong Kong and beyond will depend on real progress in cutting U.S. farm subsidies and trade barriers.

A successful Doha Round would lower trade barriers for a whole swath of industrial products and services. A 2001 study by Drusilla Brown at Tufts University and Alan Deardorff and Robert Stern at the University of Michigan estimated that even a one-third cut in tariffs on agriculture, industry, and services would boost annual global production by $613 billion, including $177 billion in the United States—or about $1,700 per American household. Some of the country’s most competitive sectors, including information technology, financial services, insurance, and consulting, probably would increase their share of global markets if the Doha Round were successful. Farm reform remains the key.

A common argument against liberalization is that the U.S. should hold onto its agricultural tariffs as “bargaining chips” in WTO negotiations. The worry is that if we were to dismantle our barriers unilaterally, other countries would lose any incentive to give up theirs.

But reducing protectionism would not primarily be a “concession” to other countries. It would be a favor to ourselves. In the process we would set a good example and create good will in global negotiations, inviting other countries to join us in realizing the benefits of lower domestic food costs.

3. Budget Savings and Equity for U.S. Taxpayers

To read the other benefits, go 

Subsidies Hurt Farmers, Business, Medicine-In Short, Everyone

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4.What's New in US Health Care: HealthPlan4Life, Steve Barchet, Coordinator 

[At a recent breakfast forum on HSA/CDHPs, I shared with some physicians the attached brief set of 7 reasons HSAs might benefit subscribers, patients, and their clinicians. I wish the thoughts were totally original but they are not -- hence giving attribution to Ms. Charlotte Williamson who in 1995 sent a letter to the Editor/British Medical Journal offering reasons why giving clinical guidelines to patients may benefit both patients and clinicians. Hence my decision to adapt her assertions to reasons HSAs might benefit subscribers and patients – and physicians. From Steve Barchet, Coordinator HP4Life]


With passage of the Medicare Modernization Act in 2003, Health Savings Accounts and their companion qualified high deductible insurance advocates and opponents have registered widely varying assertions for and against this financing strategy and tactic.


Advocates assert the positive benefits gained by engaging people in useful decisions involving optimal management of their health and health risks through purchase of and enrollment in “Consumer Driven Health Plans”.  


Much has been reported and discussed about the potential for positive benefits, but for our purposes of discussion at this early AM Breakfast Forum:


Why might Health Savings Accounts be beneficial for subscribers/patients?

1.                   HSAs help subscribers gain a sense of control over medical interventions and patient interactions with a physician and the members of the healthcare team.


2.                   HSAs encourage patient-physician discussion thereby enhancing for each a sense of personal freedom. It has been stated “…clinicians should be responsible to their patients, not for them.”


3.                   HSAs add to improved informed consent and the choices resulting from increased patient-clinician discussion.


4.                   HSAs are likely to contribute to patient safety by encouraging patient involvement and engagement in their own best interest when undergoing clinical transactions.


5.                   HSA subscribers are likely to engage in increased compliance with directions for treatments and prescribed pharmaceuticals.


6.                   HSA subscribers are likely to be more sensitive to their clinical care experiences.


7.                   HSA subscribers are likely to continue and maintain positive behaviors.


To review the extensive HealthPlan4Life, please go to

To review the final report, please go to

5.  Health Plan USA: Where are we now? Ideal HealthPlan: Portability? HSA Revolution

Steve Barchet has introduced us to some important concepts for our personal health plan, which should stand us in good favor for a healthy life. Please refer to the first four pages of the “Final Report” above to get the over view.

Characteristics of an Ideal Health Care System by John Goodman, PhD, President, NCPA

This has been discussed in section six above.

Making Health Insurance Portable

One of the strange features of the U.S. health care system is that the health plan most of us have is not a plan that we chose; rather, it was selected by our employer. Even if we like our health plan, we could easily lose coverage because of the loss of a job, a change in employment or a decision by our employer. These problems affect all Americans, but lack of individually owned, personal and portable health insurance has its greatest impact on older workers, who are more likely to have health problems.

For further background information on Making Health Insurance Portable, please go to

Health Savings Accounts Will Revolutionize American Health Care:

The idea behind Health Savings Accounts (HSAs) is quite simple. Individuals should be able to manage

some of their own health care dollars through accounts they own and control. They should be able to use

these funds to pay expenses not paid by third party insurance, including the cost of out-of network doctors and diagnostic tests. They should be able to profit from being wise consumers of medical care by having account balances grow tax-free and eventually be available for nonmedical purchases. As of January 1, 2004, 250 million nonelderly Americans now have access  to HSAs, provided they are combined with

catastrophic insurance.

Creating a Level Playing Field for Individual Self Insurance. Health Savings Accounts Are Designed To Help Correct A Major Flaw In Tax Law That Distorts Our Entire Health Care System.  Every Dollar An Employer Pays For Employee Health Insurance Premiums Avoids Income And Payroll Taxes. For A Middle-Income Employee, This Generous Tax Subsidy Means That Government Is Effectively Paying For Almost Half The Cost Of The Health Insurance. [See Figure I.] On The Other Hand, The Government Taxes Away Almost Half Of Every Dollar Employers Put Into Savings Accounts For Employees To Pay Their Medical Expenses Directly. The Result Is A Tax Law That Lavishly Subsidizes Third-Party Insurance And Severely Penalizes Individual Self-Insurance. This Encourages People To Use Third-Party Bureaucracies To Pay Every Medical Bill, Even Though It Often Makes More Sense For Patients To Manage Discretionary Expenses Themselves.

A Brief History of Health Savings Accounts:

As of January 2004, 250 million non-elderly Americans have access in principle to health savings accounts (HSAs). Individuals will now be able to self insure for some of their own medical needs and manage some of their own health care dollars.

Be sure to read a Brief Analysis of the history at

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6.Doctors Restoring Accountability in Medical Practice by Non Participation in Insurance and Government Programs

  • 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 Stay tuned for their next innovative move in designing the healthcare system for the entire country of Antigua and Barbuda.
  • 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, no Medicaid, no HIPAA, just patient care. Dr Harris is also 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

·         PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. 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.

  • PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist states: "Our point-of-care payment clinic makes acute and chronic primary medical care affordable to the uninsured of our community by refusing to accept any insurance (along with the hassles and crushing overhead that inevitably come with it).  Read the rest of the story at
  • Dr Vern Cherewatenko has success in restoring private-based medical practice that 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. Nimish Gosrani has set up a blend between concierge medicine and a cash-only practice. “Patients can pay $600 a year, plus $10 per visit, to see him as many times in a year as they want. He offers a financing plan through a financing company for those unable to plop down $600 all at once.” Patients may also see him on a simple fee-for-service basis, with fees ranging from $70 for a simple office visit to $300 for a comprehensive physical. Dr. Gosrani reports that he saves two hours per day that he used to spend dealing with insurance company paperwork. To read more, go to
  • Dr. Elizabeth Vaughan is another Greensboro physician who has developed some fame for not accepting any insurance payments, including Medicare and Medicaid. She simply charges by the hour like other professionals do. Dr. Vaughan's web site is at, where you can see her march in a miniskirt (which doctors should not be wearing) for Breast Health without a Bra. You may change your habits if you read her entire page.

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Please note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.

ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the twenty hours per week of 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

Del Meyer, MD, CEO & Founder

HealthPlanUSA, LLC

6620 Coyle Ave, Ste 122, Carmichael, CA 95608

Words of Wisdom

Allan Bloom: "Today man believes there is nothing in him, so he accepts anything" (Mind, 81)

Some Recent Postings

Medicare Reform: Pharmacy Benefit Program—What Must Be Done a Clinician’s Point of View: 

On New Year’s Day in History

Three American Revolutionary heroes were born:

In 1735:          Silversmith Paul Revere

In 1752:          Flag maker Betsy Ross

In 1745:          General “Mad” Anthony Wayne

On this New Year’s Date in 1808: The U.S. Congress officially prohibited African slave trade.

In 1863:          President Lincoln issued the Emancipation Proclamation

In 1898:          Brooklyn merged with Manhattan

In 1905:          The Trans-Siberian Railway started its maiden voyage

In 1909:          Barry Goldwater was born

In 1935:          The colonies of Cyrenaica, Tripoli, and Eezaan united to form the country of Libya

In 1942:          Twenty-six nations signed the United Nations Declaration