Community For Affordable Health Care

Vol V, No 4, January, 2007

Utilizing the $1.4 Trillion Information Technology Industry

To Transform the $1.8 Trillion HealthCare Industry into Affordable HealthCare

In This Issue:

1.         Featured Article: SelfCare - Essentials of 21st Century Health Care Reform

2.         In the News: Fast Food Arby’s CEO Runs MinuteClinic

3.         International Medicine: Reforming the State Healthcare Monopoly

4.         Medicare: Hospital Stays Can Be Decreased by Increasing Co-Payments

5.         Lean HealthCare: The True Origins of Lean Health Care – Permanente

6.         Medical Myths: Air Pollution is Increasing Asthma

7.         Overheard on Capital Hill:  Environmental Confusion in Congress

8.         What’s New in US Health Care: Capitalism Prescription

9.         Health Plan USA: Focus on the Private System – Between Medicaid and Medicare

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

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1.         Feature Article: SelfCare - Essentials of 21st Century Health Care Reform

Proposals to healthcare reform should be judged not on the goodness of their intentions but rather on the basis of their results – in other words: nobody washes a hired car  by Dr Fred Hansen

[Insights from the UK and their NHS for the world health care outlook.]

The focus on consumer choice within both major parties seems to respond to the core weakness of the British health system, as reported by patients (A Coulter, Picker Institute BMJ: 331, 19/11/05, pp 1199). The deplorable heritage of the NHS - its cold war bureaucracy and a paternalistic doctor-patient relationship – is the very opposite of choice. And there are many doubts whether the recently introduced patient choice between hospitals for elective surgery is the most urgent kind of choice that people are coveting. Over 500 consultants of Doctors for Reform have declared: “The NHS was conceived more than half a century ago, at a time of rationing and considerable poverty. We once believed it was the finest healthcare system in the world. Today few healthcare professionals would make that claim.” Indeed Britain seems to be coping worse than other Western countries with soaring health costs and is dramatically falling behind other Western countries in such crucial things as cancer survival rates.

The intangible revolution

Quite a different issue is to predict the future of the NHS in a competitive global health market. As everybody knows, here are economies of scale, particularly in purely knowledge-based goods. This is what some experts like Roger Boothe call the intangible revolution. They maintain that the economic potential and wealth creation of the knowledge-based technology of the future is enormous. This is especially true for the health sector which in the future will produce lots of intangible products and services. But today, as a closed market, the NHS simply cannot compete with the lower prices of the much larger international markets. That’s the bad news. The good news is that the globalization of healthcare services and products is the best way to contain exploding costs everywhere. Surprisingly loss of control over health expenditures happens in very many countries, regardless of ideology and the way health care is organized – from central Europe to the United States of America.

Control over health expenditure is the main challenge

Some countries have already responded to exploding costs with incentives to save money at the origin of all health expenditures: the patient or consumer. These ideas try to encourage more responsibility by healthcare users. . .

Public confidence in health reform is dwindling

Unfortunately nothing like this is happening in Britain, except in some private insurance companies. Not surprisingly, 54% of electors don’t believe that the billions of pounds that Labor has been pouring into the NHS since 2000 will result in real improvements, and only 39% agree that it will do so. . . In a recent MORI poll 44% of people said they expect the NHS is getting worse, only 22% held the opposite opinion. Other surveys have suggested that the American managed care organization Kaiser Permanente was much more cost effective than the NHS run programs (BMJ 24 August 2004). The crucial difference between both was that Kaiser employed many more consultants per patient than the NHS.

Social and medical Progress

The NHS was founded in times when political and social collectivism prevailed – as were the dominant concepts of epidemic and contagious diseases. And this is reflected not only in the health bureaucracies created by Aneurin Bevan but even today in the top-down centralism of the NHS. But social and medical progress renders those collectivist concepts obsolete. . . 

Dramatic change of disease burden

Past social progress and ongoing medical innovation have led to a fundamental transformation in the disease burden, due to changes in two major areas.

Firstly the affluent Western societies created a lifestyle which is outright unhealthy. It is to blame for the leading causes of death these days: coronary heart diseases, stroke, many different cancers, sexually transmitted diseases, asthma, diabetes and fatalities of poly-pharmacy. This lifestyle encompasses smoking, overeating, promiscuity with unprotected sex, abuse of illicit drugs like cocaine and alcohol and lack of exercise. In response, we consume vast amounts of medicines in the attempt to postpone or avoid any deterioration of health. Prudent disease prevention and health improvement through healthy lifestyles are the exception.

Secondly, globalization with mass tourism and mass immigration has introduced or brought back a host of infectious and tropical diseases to the Western societies. These include the reemergence of tuberculosis as a corollary of the HIV epidemic, diphtheria and other infectious diseases. International sex tourism also has given a booster to sexually transmitted diseases. All these factors and the masses of new immigrants with no or poor English language skills have put our Western health systems, not at least the free-for-all English NHS, under considerable pressure.

Not surprisingly, according to a survey by the think tank Reform, the productivity of the NHS has constantly declined over the last decades despite a huge increase of the NHS budget.

Since unhealthy lifestyles are to blame for much of the Western disease burden, this is where we need to look first in terms of keeping healthcare costs under control. Simple exhortation is not enough, as we have seen on the obesity epidemic for example.

So how can we achieve sustainable ways of behavior or lifestyle changes?

Setting the right incentives for consumer choice

The most promising solution would be to give patients/consumers back responsibility for their own health, and control over their own health care expenditures. Only thus we can contain the progress of chronic diseases driven by lifestyles in which peoples damage their own health. The clue is self-reliance and incentives for people to look after their own health, supported by full access to health information via the web and a viable health insurance system. Previous attempts to get people to live healthier have failed because they lacked any economic underpinning or incentives to do the right thing. But at least they may have raised awareness of the problem.

Patients value self-care high

According to surveys (Picker Institute, Oxford) most patients value preventive advice and support for self-care high. But our healthcare system does not offer any reward or incentive for combined efforts of doctors and patients to achieve this. . .

Health care funding needs to be linked to personal risks and lifestyle

Abandoning third-party payment systems is the truly global solution to the health care crisis. It is the way to make health care systems sustainable over the generations. It clearly implies a turn to individualized methods of raising health care funds: only this allows different patterns of individual health risks to be taken into account. It implies a competitive insurance system of staggered premiums according to different risks. Only then we might accomplish a fully patient/consumer-driven health care.

Provision of health care by private companies is not enough

The tax-funded system of health care in this country has become counterproductive. It does not give any incentive to prevent or avoid diseases. As a result not only should the provision of health care be decentralized, but also opened up to market forces, as initiated by the Tories and continued by New Labor.

However, if only the delivery of health care is privatized there remains the problem of collective or state purchasing of health services. Any kind of third party commissioning as a proxy for patients is prone to bureaucratic failures and complexity. Probably the most advanced concept, although not implemented yet, has been developed by Newt Gingrich at the Washington based Center for Health Transformation (CHT). He is attempting to abolish third-party payments in all US public healthcare provision under Medicaid and Medicare.

This means that the patient acquires full consumer power since he is put in control of all health expenditures on his behalf. The crucial point of a consumer-driven healthcare system will be the direct link between personal lifestyle and individual control of health expenditure with fully informed consumers. . .

Markets can best address inequalities in health

Contrary to the prevailing prejudice, healthcare is not much different than other sectors where the market prevails. True, the bulk of our healthcare resources are taken up only in the last couple of years before we die. . .

Evidence that the new concept will work

Evidence that a combination of activity, attitude, and good nutrition, can actually achieve a significant improvement in health and can prevent or at least postpone chronic diseases was provided by scientists at Nestlé - most of all in the area of obesity and diabetes. They have also proven that the improvement of physical health will make a huge difference in figures of mental health - showing that there is a strong connection between both. It is not at all surprising that lifestyle changes like increased physical activity and weight loss will also decrease depression and anxiety. Without treatment depression and anxiety can result in unemployment, unnecessary disability, substance abuse, inappropriate incarceration, suicide and homelessness.

The challenges for self care

The self monitoring of health parameters and introduction of personal risk management will be big challenges, but well worth it. Special bespoke software programs for consumer health control solutions need to be developed in the near future. If instead of just one third of the British population being able to maintain a normal body weight, two-thirds could do so, then the disease burden or work load for the health service could be nearly halved.

Contrary to the common belief free access to the health service without payment does not serve the patient because it is an invitation to neglect your health and leads to a general waste of resources. One example for this is that, according to a recent survey (Picker-Institute, Oxford) British patients, used to the NHS, are less inclined to get involved in health improvement than patients in almost all other European countries. Another example is the millions of missed appointments with consultants, GPs and nurses in the NHS.

Public health is to be reconsidered

Fifty years of Public Health in the NHS have witnessed a complete failure to improve the health of the population at large. Apart from vaccinations in childhood and cancer screening, which are more or less established in all Western countries and not a merit of NHS-style public health, most other public health interventions to target things like cholesterol, weight and blood pressure have failed. There is poor evidence that this kind of public health interventions achieve any long-term health improvements. Admittedly, in other Western countries the results are not any better. It is therefore as true for state health interventions as for other things: market forces tend to be the stronger. . . 

Doctors for Reform

Recently Doctors for Reform rejected the current tax-based healthcare system in Britain. As Dr Christopher Lees, one of the founders admitted the group was disappointed by the Wanless Report’s conclusion that taxation was the best way to fund healthcare. Doctors for Reform are looking increasingly to health care systems in continental Europe, one of the favorite candidates being Switzerland which has implemented the most advanced market based health-reform - it combines mandatory social insurance with individual discounts for people who stick to a healthy lifestyle and take up less health care resources. In the Swiss system employers no longer contribute to health insurance for their employees.

. . . “The NHS as we know it has had its day”, said the founder of the group, the oncologist Professor Karol Sikora. He added, tax finance is simply no longer fair because people with a healthy lifestyle have to subsidize people, who knowingly damage their health in a variety of ways. Indeed the NHS provides incentives not to bother about one’s health and even to remain ill in order to get the most out of the NHS. It is another example of the welfare state that actually encourages people to the opposite of what it seeks to achieve. James Bartholomew has looked into this in his book “The Welfare State we are in”. . .


How can we implement this new concept of consumer driven health care?

To read the answer as well as the entire original article, go to

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2.         In the News:  Fast Food Arby’s CEO Runs MinuteClinic, Fast Company

The Quick Fix:  MinuteClinic by Michael C. Howe

Welcome to drive-thru health care: It’s conveniently located inside your local Target, CVS pharmacy, or supermarket; it’s quick, cheap, and stays open late and on weekends. Physician assistants or nurse practitioners (not doctors) will diagnose, and prescribe drugs for, the dozen most common ailments—your ear infections, your allergies, etc.—for between $28 and $110 (about half of what you’d pay at a doctor’s office and a fraction of the cost of an ER visit). And no appointment is necessary.

When MinuteClinic hired CEO Michael C. Howe last June, the five-year-old company had 22 locations in Maryland and Minnesota; today it runs 90 clinics from Seattle to Raleigh-Durham, North Carolina, and is shooting for 300 in 20 states by year’s end and 800 by 2010. The potential upside in the $1.9 trillion health-care industry seems endless (a growing list of competitors apparently agree).

Howe, a former CEO of Arby’s, predicts that his short-order approach will transform the healing arts. He says his run as a sandwich mogul gave him “an appreciation of the importance of the customer, or in this case, the patient.” If it gives you pause to have a roast-beef professional overseeing little Suzy’s lab results, know that after 360,000 patient visits, MinuteClinic reports a 99% satisfaction rate. And Dr. Stephen Schoenbaum, executive vice president for programs at the Commonwealth Fund, a nonpartisan health-care grant-making and research tank, gives the clinics a qualified thumbs-up: “My one concern would be continuity” of care, he says. But “our health-care system at the moment is so fragmented that [continuity] is only a small component in a very large problem.”   --Anya Kamenetz

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3.         International Medicine:  Reforming the State Healthcare Monopoly by Dr Eamonn Butler

Extending access to quality healthcare through diversity and competition. Adam Smith Institute

Despite the billions poured into Britain’s state-run healthcare system, people still face long waits and complain of unresponsive service. But that is no surprise in such a centralized tax-funded monopoly. Its sheer size makes it impossible to manage, while its politicization makes it impossible to reform.

Instead, we should follow the lead of almost every other country, and shift the balance of healthcare spending away from tax and more to the individual. There are many examples of social-insurance systems, tax credits, and direct payment plans that give healthcare users real customer power over the providers, while still ensuring that everyone has full access to the care they need.

At the same time, we need to transform today’s state monopoly providers into independent, competitive ones – giving them the incentive to drive improvement and ensure that users are fully satisfied with the service they receive.

To read the whole story, please go to

Dr Eamonn Butler is director of the Adam Smith Institute, an influential think-tank which for more than twenty years has designed and promoted practical policies to promote choice and competition in the delivery of essential services. Independent and non-partisan, the Institute was at the intellectual leading edge of the UK debate on privatization, including the sale of state enterprises, the commercialization of government agencies, contracting-out of local services, and the introduction of internal markets in health and education.

Having graduated from the University of St Andrews in the 1970s, Dr Butler worked on pensions and welfare issues for the US House of Representatives in Washington DC. Returning to the UK, he served as editor of The British Insurance Broker monthly before devoting himself full-time to the Adam Smith Institute, which he helped found.

To read more of Dr. Butler’s biography, go to

Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canada’s Supreme Court

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4.         Medicare: Hospital Stays Can Be Decreased By Increasing Co-Payments

The largest-ever study on the effects of health care co-payment costs on emergency department visits has revealed that requiring patients to pay for a portion of the cost can reduce the number of visits. The study also finds that this decrease does not negatively affect health.

”The results of this study are encouraging in that these modest co-payments appeared to reduce health care use, and therefore overall costs, without harming patients,” says Dr. John Hsu, lead author of the study.

While emergency visit rates decrease substantially as the co-payment increases, the findings show no increase in the rate of unfavorable clinical events (hospitalization, intensive care admission) and no increase in deaths.

The population-based experiment followed over two million commercially insured and 250,000 Medicare insured patients.

This study is published in the October issue of Health Services Research.

The federal government did the same type of study prior to offering Medicare. That study showed that a co-pay as low as $5 cut demand for medical care by 50%. Then the Leftists forced Supplemental Insurance to come about to alleviate the patient paying the co-pay.

Funny how it is continually necessary to prove the world is not flat.  –Bob, a MedicalTuesday Member.

Dr. Hsu is an internist and health services researcher in the Kaiser Permanente Division of Research and a fellow at the Institute for Health Policy. Dr. Hsu is the principal investigator on two AHRQ and NIH sponsored studies on patient cost-sharing.

Health Services Research (HSR) provides those engaged in research, public policy formulation, and health services management with the latest findings, methods and thinking on important policy and practice issues. Providing a forum for the expansion of knowledge of the financing, organization, delivery and outcomes of health services, HSR also allows practitioners and students alike to exchange ideas that will help to improve the health of individuals and communities. HSR is published on behalf of Health Research and Educational Trust in cooperation with AcademyHealth. For more information, please visit:

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

- Ronald Reagan

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5.         Lean HealthCare: The True Origins of Lean Health Care - Permanente

Dr Garfield’s Enduring Legacy—Challenges and Opportunities, Jay Crosson, MD

It’s about time. For too long, Sidney Garfield, MD, has stood in the giant shadow cast by his more celebrated partner and friend, Henry J Kaiser, the great entrepreneur and industrialist. Mr Kaiser’s name and fame live on, mainly in association with the only nonprofit organization ever incorporated by the builder of more than 100 for-profit companies—Kaiser Permanente (KP). But the physician whose extraordinary vision and daring innovations in health care delivery that gave birth to that same organization remains largely unrecognized beyond the select circle of medical historians and the heritage-minded physicians and staff of KP.

One needn’t minimize the vital role of Mr Kaiser in KP’s story to assert the seminal role played by Dr Garfield. They were genuine partners, each bringing to the enterprise critical elements lacking in the other: money and organizational genius from Mr Kaiser; a visionary mind and an unrelenting drive for innovation and quality improvement from Dr Garfield; and from both a genuine belief in and commitment to human dignity and progress.

This centennial of Dr Garfield’s birth is a timely occasion not only to recall and celebrate his role in creating and evolving the unique model of health care delivery that would become KP, but to examine as well some of his key insights and innovations with regard to the current and future state of American health care. Fortunately, Dr Garfield himself articulated his ideas in a number of influential documents. These included, most importantly, his 1945 address to the Multnomah County Medical Association in Oregon, in which he spelled out the essential elements of what we have come to call Permanente Medicine, and a forward-looking article in the April 1970 issue of Scientific American2 (see page 46). In that article, he reiterated those foundational qualities and went on to anticipate a radical transformation of the health care system via the incipient power of information technology. In addition, the evolution of his ideas was expertly traced and recorded by his physician colleague John Smillie, MD, in his excellent 1991 history of KP, Can Physicians Manage the Quality and Cost of Health Care?

Anyone who has examined Dr Garfield’s long career will appreciate the difficulty of assessing the historical and/or current relevance of his ideas and innovations. As his diminishing number of surviving colleagues will attest, he was a fount of ideas—virtual intellectual fireworks—admittedly igniting a few duds among the brilliant rockets. The ideas ranged across the entire spectrum of health care, from delivery models to financing to hospital design. In the end, it may fairly be said that he achieved his childhood dream of becoming an engineer (he is said to have broken down and cried when his parents insisted he attend medical school) by engineering our unique model of health care.

But among all his many lasting contributions, which ones constitute the essential core of his life’s work? And what relevance do they have for today and tomorrow?

I believe Dr Garfield’s lasting reputation will rest on four big ideas that, individually and in combination, powered fundamental transformations in health care. They are:

·         the change from fee-for-service to prepayment

·         the promotion of multispecialty group practice in combination with prepayment

·         the emphasis on prevention and early detection to accomplish what he termed “the new economy of medicine,” in which providers would be rewarded for keeping people healthy; and,

·         finally—and most presciently—the centrality of information technology in the future of health care.

Significantly, each one of these 20th century innovations, three of which are deeply embedded in KP’s own genetic code, is at or near a critical crossroads in this first decade of the 21st century, either still struggling for broad acceptance or under fresh assault as failed assumptions. Let us briefly examine each in turn.

To examine these four fundamental principles, please go to

Most important, the principles themselves are not the object of Permanente Medicine. If there are better ways to achieve the ends of Permanente Medicine—defined by Dr Garfield himself as “to provide the best quality care our members can afford”—we should never be shy about making corrections, adjustments, refinements, or wholesale changes when demanded by our own 21st century environment. Permanente Medicine—Dr Garfield’s great gift to American medicine—will endure only so long as it remains a living, growing, adapting way of practicing medicine.

To read more about the centennial of Dr. Sidney R Garfield’s birth, the Founder of Permanente, and his partnership with Henry J Kaiser, please go to

To read Dr. Garfield’s seminal article in Scientific American in 1970, click on The Delivery of Medical Care at the above URL.

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6.         Medical Myths: Increasing Air Pollution is Increasing Asthma.

Facts Not Fear on Air Pollution by Joel Schwartz,

Executive Summary:

Air pollution has been declining for decades across the United States, yet most Americans still believe air pollution is a growing problem and a serious threat to their health.  The reason: most information on air pollution from environmentalists, regulators and journalists - the public’s main sources for information on the environment - is false.  Air quality in America’s cities is better than ever. Between 1980 and 2005:

·         Fine particulate matter (PM2.5) declined 40 percent.

·         Peak 8-hour ozone (O3) levels declined 20 percent, and days per year exceeding the 8-hour ozone standard fell 79 percent.

·         Nitrogen dioxide (NO2) levels decreased 37 percent, sulfur dioxide (SO2) dropped 63 percent and carbon monoxide (CO) concentrations were reduced by 74 percent.

·         Lead dropped 96 percent.

What makes these air quality improvements so extraordinary is that they occurred during a period of increasing motor vehicle use, energy production and economic growth. Between 1980 and 2005:

·         Automobile miles driven each year nearly doubled (93 percent) and diesel truck miles more than doubled (112 percent);

·         Tons of coal burned for electricity production increased about 61 percent; and

·         The real dollar value of goods and services (gross domestic product or GDP) more than doubled (114 percent). 

Air pollution of all kinds declined sharply because of cleaner motor vehicles, power plants, factories, home appliances and consumer products.

Not only are Americans unaware that air quality has improved, they also harbor fears about air pollution that are out of proportion to the minor health risks posed by today’s historically low air pollution levels: 

·         The prevalence of asthma rose 75 percent from 1980 to 1996, and nearly doubled for children; however, air pollution cannot be the cause, since it declined at the same time asthma increased.

·         Emergency room visits and hospitalizations for asthma are lowest during July and August, when ozone levels are highest. 

·         Reducing nationwide ozone from 2002 levels (by far the highest levels of the last six years) to the federal 8-hour ozone standard would reduce respiratory hospital admissions by 0.07 percent and asthma emergency room visits by only 0.04 percent, according to the Environmental Protection Agency (EPA) and California Air Resources Board (CARB).

Regulators, scientists and journalists have all played a role in perpetuating baseless fears.  For example:

·         Studies that report harm from air pollution are more likely to be published and receive press coverage than studies that do not. 

·         Government officials fund much of the research, and the funding is provided with the explicit intent to provide proof of harm from air pollution.

·         Regulators create fear through regional air pollution alert systems, such as “code red” days; even though pollution levels are dropping, the number of warnings increases because of increasingly tighter standards.

This constant stream of alarmist studies and air pollution warnings maintains unwarranted anxiety that air pollution is causing great harm.  Furthermore, omission of contrary evidence on air pollution and health is common among researchers, journalists, activists and regulators, causing claims of harm from air pollution to appear more consistent and robust than suggested by the actual weight of the scientific evidence.

None of this would matter if air pollution could be reduced for free.  But reducing air pollution is costly.  Attaining the federal standards will cost tens to hundreds of billions of dollars per year.  These costs are ultimately paid by people in the form of higher prices, lower wages and reduced choices. 

Some requirements are especially counterproductive.  For example, New Source Review (NSR) requires businesses to install “state-of-the-art” pollution controls to achieve the lowest possible emission rates when they build new plants.  This gives businesses an incentive to keep older, less-efficient and higher-polluting plants operating well beyond their useful lives, rather than build less-polluting new plants.  NSR harms consumers by slowing the pace of pollution reductions, raising the cost of any pollution reductions that do occur, and increasing the prices of consumer goods by slowing innovation and reducing competition.

Perhaps the most harmful aspect of the air quality regulation is that it has no negative feedbacks that would slow down or stop its bureaucratic expansion.  Regulators’ jobs and powers depend on a public perception that air pollution is a serious and urgent problem.  But regulators also fund much of the research intended to demonstrate the need for more regulation, and fund environmental groups to agitate for increases in regulators’ powers.  Regulators also set the level of the health standards, meaning that they get to decide when their job is finished.  Naturally, it never will be.  And as the standards are tightened, the number of daily air pollution “alerts” increases, even as actual air pollution levels continue to decline.

The bureaucratic incentives built into air quality regulation explain why regulators and activists work so hard to make it appear that air pollution is still a serious problem, even as air pollution has reached historic lows that have, at worst, minor effects on people’s health. 

Air pollution affects far fewer people, far less often and with far less severity than regulators, environmentalists, health scientists and journalists have led Americans to believe.  By pursuing tiny or nonexistent health benefits at great cost, air pollution regulations are making us worse off.

To read the details of the story, please click below or go directly to

  1. Introduction
  2. Myth No. 1: Air Quality Is Bad and Getting Worse
  3. Myth No. 2: Air Pollution at Current Levels Is a Serious Threat to Health
  4. Myth No. 3: Federal Air Regulations Make Americans Better Off
  5. Conclusion
  6. About the Author

Facts: Air Pollution is decreasing despite increasing automobile usage and industrial expansion.

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7.         Overheard on Capital Hill:  Environmental Confusion in Congress

Deming to Congress: Public Misinformed

There is an overwhelming bias in the media regarding the issue of global warming, NCPA E-Team Adjunct Scholar and University of Oklahoma Professor David Deming testified before Members of the Senate Environment and Public Works Committee.  “In the past two years,” Deming said, “this bias has blossomed into an irrational hysteria.  Every natural disaster that occurs is now linked with global warming, no matter how tenuous or impossible the connection. As a result, the public has become vastly misinformed.”

Deming told Senators that a reporter for National Public Radio once offered to interview him about one of his climate studies, “but only if I would state that warming was due to human activity. When I refused, he hung up.”

Regulators Exaggerate Pollution Risks

Air pollution is not a growing problem or a serious threat to public health, according to a new NCPA study. “The truth is, air quality in America’s cities is better than it has ever been,” said Joel Schwartz, author and NCPA E-Team adjunct scholar.

“Americans harbor health fears about air pollution that are far out of proportion to the minor risks posed.”

The study is based on his book, “Air Quality in America,” due to be published in 2007 by AEI Press. Schwartz is a visiting fellow at AEI.

Environmental Confusion in Congress

Federal wetlands regulations and the Superfund program will be top priorities for the Environment and Public Works Committee, said incoming chair, Sen. Barbara Boxer (D-CA).  Boxer advanced a broad environmental legislative agenda, including reducing farm runoff pollution and improving drinking water.  She also promised to hold a field hearing to discuss environmental problems remaining from Hurricane Katrina.

Meanwhile, Sen. Larry Craig (R-ID) thinks that a Democrat-controlled Congress will not be able to pass legislation that limits emissions of greenhouse gases. Sen. Craig said that not only could Sen. Boxer’s legislative agenda not withstand filibuster, he doesn’t think incoming House Energy and Commerce Committee Chairman John Dingell (R-MI) will support her agenda.  “Climate change is an idea of the past,” Craig said. “There isn’t a nation in the world that ratified Kyoto that can meet their own standards.  It’s a dead-and-done deal. It’s just those who need an environmental agenda who want to talk about it.”

We should cut off all funding of our prejudicial public radio system with taxpayer funds.


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8.         What’s New in US Health Care: For Health Care Woes, a Capitalism Prescription By David Gratzer, Special to's Think Tank Town, October 25, 2006

Amid the Congressional page scandal, the most important pocketbook issue of the election is getting lost in the noise of the campaign season. Health care costs are not just soaring, they're reaching unaffordable levels, meaning that we'll have to look to managed care (again) or find a government solution, a prescription for rationing. With spiraling costs projected to continue, thereby doubling spending in the next 8 years, that choice will be made by 2014 unless we find a third option. What's the cure? Congress needs to administer a strong dose of capitalism.

Businesses struggle to pay for health premiums, which have nearly doubled since 2000. It's not simply corporate giants like GM that have trouble -- only 61% of American companies offer their employees health insurance, down from 69% in 2000. Even insured Americans feel the pinch -- though labor costs are up, median family income has dropped 2.6% over the past half decade, the largest decline since the last recession, in large part because soaring health premiums have swallowed up new money.

The situation will precipitously worsen in the next seven years as health spending is projected to rise to $4 trillion dollars a year, up from $2 trillion. Former Health and Human Services Secretary Tommy Thompson declares this unsustainable, noting that as a percentage of GDP, US spending will soar from 16 percent to 21 percent. 2013 holds more problems: Medicare will start drawing dollars from the U.S. Treasury.

But for employers, employees, and government officials already fretting the cost of health care, beware: you haven't seen anything yet.

For years, the debate has been about 2 options for dealing with the cost crunch.

First, embrace HMOs. The idea faltered in the late 1990s but managed care held costs relatively stable in the mid-1990s (rising, for example, just 2 percent in 1996). But HMOs turn basic decisions over to bureaucrats, a paternalistic philosophy at odds with American values.

Second, convert to some type of government health care, an approach every other Western country has adopted. Though the idea grows in popularity -- California legislators recently passed single payer legislation -- socialized medicine is built on rationing care, forcing the sick and elderly to wait for even the most basic care in countries like Canada.

Is there another option? Look to capitalism, which governs the other five-sixth of the economy. Ultimately, we must choose market reforms.

That may sound easy enough, but for more than 60 years, government policy has drifted fitfully in the opposite direction. In the rest of the economy, we have moved away from regulations, price controls, and overreaching government agencies. Yet in health care, we have distorted the tax code, bulked up the Medicaid rolls, and let a million regulations bloom. Medicare alone has more than 100,000 pages of them. Price controls are endemic to Medicare and Medicaid. The result is a half-broken, semi-socialist system, low in satisfaction and high in cost.

How to employ market reforms? Here are five simple steps. . . To read these and the rest of the article, please go to

David Gratzer, a physician, is a senior fellow at the Manhattan Institute for Policy Research. He is the author of The Cure: How Capitalism Can Save American Health Care (Encounter Books).

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9.         Health Plan USA: Focus on the Private System – Between Medicaid and Medicare

As our focus group reviews the health systems of the world and compares them with the current U.S. healthcare system, we notice a complete disconnect between where we are and where we want to go. Almost every proposal suggests a plan for implementation by Congress to solve the conundrum, or a plan that requires Congressional funding. A plan that saves taxpayer’s dollars or is totally in the free market is not an interest of Congress. This can also be seen by recent news from Canada. The Canadian Medical Association elected a new president that will bring about a change in Canadian Medicare. One of his proposals would reduce the costs of surgeries by 40%. But it could not be accepted by the government. Why do we waste time appearing before Congressional Committees?

Dr. Brian Day, the President-Elect, is not simply a critic of Canada's health care system, he is arguably the most vocal and articulate one. He told The New York Times in an interview, "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years." He has not simply suggested alternatives to the status quo but, literally, built one, in the form of his private surgery centre. Several years ago, he went so far as to offer to take over the majority of surgeries of the local regional health board for 60% of its present cost. (The NDP government at the time bristled.)

Dr. Day, in some ways, is an unusual messenger. He grew up in a socialist home in Liverpool; both of his parents voted Labour. He claims that in his first 15 years of practicing medicine, he had strongly supported a government-run system. His enthusiasm waned: "When you find that your operating-room time is cut from 22 hours a week progressively over the years to five hours a week," he told CBC Radio, "and you have 450 patients waiting for health care, you realize that something has to give." Today, Dr. Day operates the largest private clinic in the country, providing a host of surgical procedures on a for-profit basis. His views on health care have made national and international news.

We have many physicians who are increasingly supporting a government-run system. It is important to maintain a dialogue with our colleagues so we don’t have to go through the unfortunate learning process that physicians in Canada, UK, and elsewhere are now experiencing having been deluded for decades. It becomes far more difficult for them to make the change than for us to become aware of the disaster that awaits us in a government-run system.

The answer to our country’s health care challenges will reside primarily in the private or free-market sphere. We’ve presented a number of articles in this quarterly report which shows global vital activity and thinking about these issues. We appreciate the responses we have received. If yours has not been acknowledged, be sure that we read all of them and respond and incorporate your responses and suggestions as time permits.

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10.        Restoring Accountability in Medical Practice by Non Participation in Government Programs and Understanding the Devastating Force of Government.

·         Grover Norquist, President of Americans for Tax Reform, keeps us apprised of the Cost of Government Day® Report, Calendar Year 2006 Fourteenth Edition, Cost of Government Day (COGD) is the date of the calendar year on which the average American worker has earned enough gross income to pay off his or her share of spending and regulatory burdens imposed by government on the federal, state and local levels. Cost of Government Day for 2006 is July 12th, a one day increase above last year’s revised date of July 11th. With July 12th as the COGD, working people must toil on average 192.5 days out of the year just to meet all the costs imposed by government. In other words, the cost of government consumes 52.7 percent of national income. If we were to put health care into the public trough, the additional 18 percent would allow the government to control 70 percent or nearly three-fourths of our productivity and destroy our health care in the process. We would have almost no discretionary income. Be sure to listen to Leave Us Alone! with Grover Norquist at

·         John Berthaud, President of the National Taxpayer’s Union,, keeps us apprised of all the taxation challenges our elected officials are trying to foist on us throughout the United States. To find the organization in your state that’s trying to keep sanity in our taxation system, click on your state at  To find out How Taxpayers Fared at the Ballot Box go to

·         The Adam Smith Institute, Eamonn Butler, Director,, Extending access to quality healthcare through diversity and competition. To read about funding UK Health Care, go to

·         Ayn Rand, The Creator of a Philosophy for Living on Earth,, is a veritable storehouse of common sense economics to help us live on earth. To review the current series of very insightful Op-Ed articles, go to There will be something for everyone.

·         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

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Stay Tuned to the MedicalTuesday and the HealthPlanUSA Networks and have your friends do the same.

Articles that appear in MedicalTuesday and HPUSA may not reflect the opinion of the editorial staff. Sections 1-8 are largely 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.

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Del Meyer

Del Meyer, MD, CEO & Founder

HealthPlanUSA, LLC

6620 Coyle Ave, Ste 122, Carmichael, CA 95608

Words of Wisdom

Academics and their arrogance held that gifted elite academics could organize and run society so much better on their scientific socialist model, than the pitiful stupid ignorant masses were currently able to accomplish on their own. William Buckley’s classic response was that he would rather be governed by the first 2,000 names in the Boston telephone book than by the 2,000 members of the Harvard faculty. 

The world is governed more by appearances than by realities, so that it is fully as necessary to seem to know something as it is to know it.  —Daniel Webster 

An appeaser is one who feeds a crocodile—hoping it will eat him last.  –Sir Winston Churchill

“How can I ever show my appreciation?” asked a patient who had just recovered from a serious illness. “My dear woman,” replied the physician, “ever since the Phoenicians invented money there has been only one answer to that question.” –Medical Folklore

Some Postings from Our Archives

To understand why physicians are almost persuaded to join the bandwagon of Socialized Medicine, read the background about how they were once previously almost persuaded but came to their senses before it was too late.

Alexander Solzhenitsyn asks, “What do you mean by 'free’? Universal and public—yes. Free, no. The doctors don’t work without pay. It’s just that the patient doesn’t pay them. They’re paid out of the public budget. The public budget comes from these same patients. Treatment isn’t free, it’s just depersonalized.” 

Read last quarter’s HPUSA issue at

Find the entire archives of HPUSA at

This Year in The Future

Peter Drucker’s Message for the New Year: Integrity in Leadership

The proof of the sincerity and seriousness of a management is uncompromising emphasis on integrity of character. For it is character through which leadership is exercised; it is character that sets the example and is imitated. Character is not something one can fool people about. The people with whom a person works, and especially subordinates, know in a few weeks whether he or she has integrity or not. They may forgive a person for a great deal: incompetence, ignorance, insecurity, or bad manners. But they will not forgive a lack of integrity in that person. Nor will they forgive higher management for choosing him.


We wish each and every one of you and yours


And Freedom in Health Care to Make it Affordable to All