Community For Affordable Health Care

Vol VIII, No 4?, January, 2009

Utilizing the $1.8 Trillion Information Technology Industry

To Transform the $2.4 Trillion HealthCare Industry into Affordable HealthCare

In This Issue:            

1.         Featured Article: The Patient Safety Crusade--a Phony Crisis

2.         In the News: Obama’s Budget Director Orszag's Health Warning

3.         International Medicine: A Foretaste of the Future of American Medicine?

4.         Medicare: Obama’s Health Plan Is A Federal HMO according to Sally Pipes

5.         Lean HealthCare: Hospital Stays Can Be Decreased By Increasing Co-Payments

6.         Misdirection in HealthcareMedical Myths: 98,000 people die from medical errors each year

7.         Overheard on Capital Hill: The President Reads A Book A Week

8.         What's New in US Health Care: Creating Lean Healthcare, by Jim Womack

9.         Health Plan USA: Developing the Ideal HealthPlan for the USA

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


The Annual World Health Care Congress, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. The third year it was 50 percent, indicating open forums such as these are critically important. The 4th Annual World Health Congress was held April 22-24, 2007, , in Washington, D.C. That year many of the world leaders in healthcare concluded that top down reforming of health care, whether by government or insurance carrier, is not and will not work. We have to get the physicians out of the trenches because reform will require physician involvement. The 5th Annual World Health Care Congress was held April 21-23, 2008, , in Washington, D.C. Physicians were present on almost all the platforms and panels. This year it was the industry leaders that gave the most innovated mechanisms to bring health care spending under control. The solution to our health care problems is emerging at this ambitious Congress. Plan to participate: The 6th Annual World Health Care Congress will be held April 14-16, 2009, in Washington, D.C. The 5th Annual World Health Care Congress - Europe 2009, will meet in Brussels, May 23-15, 2009. For more information, visit The future is occurring NOW. 

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1.   Feature Article: The Patient Safety Crusade--a Phony Crisis

Written By: John Dale Dunn, M.D., J.D., Published In: Heartland Perspectives, 2006

The American health care system is the biggest business sector in the country. As a result, it is a very attractive target for ambitious politicians and policymakers, with more than $2 trillion a year in expenditures. If an ambitious group of politicians and meddlers would like to expand government, American health care is the logical target.

An effective strategy to seal the deal would be to accuse the health care system of killing people. That should undermine public confidence and soften people up for the idea that the government would do a better job.

Toward that end, in 1999 the Institute of Medicine (IOM), a government policy and science agency, part of the National Academy of Sciences, published a monograph titled To Err Is Human (1) and followed with an extensive public relations campaign accusing American hospital personnel of negligently killing as many as 100,000 people every year. This harsh and false criticism of the best hospitals, physicians, and nurses on the planet has been joined by other government-funded entities and professors at supposedly independent universities, including many medical academics.

No Crisis

There is no crisis of patient safety in American hospitals, no epidemic of medical incompetence. As a longtime medical negligence analyst, I was outraged to read the 1999 IOM news release and public relations campaign. I had previously analyzed the 1979 California and 1991 Harvard reports that the IOM was relying on and found them both to show no such crisis.

The IOM campaign actually commenced before formal publication of the Harvard 1992 study. All the studies in three separate decades showed no crisis, the same rate of incidents, so there was clearly no epidemic. The rates of negligent injury were very low for such a complicated human activity, less than a quarter of a percent consistently in all the studies. Nonetheless, all the experts were declaring a catastrophe.

Voices of Reason

Fortunately, the patient safety crusade and the IOM failed to anticipate the opposition of a nationally prominent patient safety expert, an honest Harvard physician and attorney named Troyen Brennan.

Troyen Brennan M.D., J.D. was the lead Harvard researcher on the two studies that were used as the backbone of the IOM report. Dr. Brennan wrote in the New England Journal of Medicine in April 2000, four months after the IOM announcement of a crisis:

·         "I have cautioned against drawing conclusions about the numbers of deaths in these studies."

·         "The ability of identifying errors is methodologically suspect."

·         "In both studies [New York and Utah/Colorado] we agreed among ourselves about whether events should be classified as preventable. ... These decisions do not necessarily reflect the views of the average physician, and certainly don't mean that all preventable adverse events were blunders." (2)

Other safety experts add the same note of caution. As part of its crusade against non-government health care, the IOM announced a major safety problem with adverse drug events (ADEs). Jerry Avorn, M.D., an expert on drug events, writing in the Journal of the American Medical Association (JAMA), said in an editorial about a couple of ADE reports: "These two studies push hard at the boundaries of clinical epidemiology and health services research, and a skeptic might wonder whether the envelopes of these disciplines might not have gotten a bit nicked in the process." (3)

Dr. David Bates, another safety expert, in a Journal of the American Medical Association editorial commenting on another drug event study, said the ADE studies have problems, such as whether the events are properly identified and evaluated and whether they are really avoidable in a practical sense, particularly in severely ill patients. (4) The millions of drug administrations daily in American hospitals present an opportunity for data-dredging and manipulation.

Only Three Studies

For all the panic that has been raised, there have been only three patient safety studies, conducted in 1974, 1984, and 1992.

The first study was conducted by Don Harper Mills, M.D., J.D., a pathologist and attorney for the California Medical Association. With three associate attorney/physicians, he looked at care in California hospitals in 1974. They studied about 20,000 patient charts. (5)

The second study examined care in New York hospitals in 1984. It was conducted by a group from Harvard that included Dr. Brennan and Lucien Leape, M.D. They studied 30,000 charts. (6,7,8)

The third study reported on patient care in Utah and Colorado hospitals in 1992. It was the Harvard group's second study, led by Dr Brennan. They looked at 15,000 charts. (9-13)

Same Results

All these studies showed the same results with only slight differences: a 1 percent rate of negligence events of some kind and less than a 0.25 percent rate of negligent injury or death.

I reviewed a study of 300,000 hospital charts by the Texas Medical Foundation (TMF) from 1989 to 1992 and found even lower numbers of negligence and injury in a higher-risk patient group: the elderly. The California (1974) and Harvard (1984,1992) studies found a rate of 0.25 percent cases with negligence injury or death. In the TMF study the rate was even lower, less than 0.2 percent, and the much larger Utah/Colorado study from 1992 showed some improvement, a decline in the rate of negligence and injury or death. (14-17)

There is no patient safety crisis in the United States. Nurses, doctors, and hospitals aren't killers; they are healers. The current crusade is irresponsible and based on junk science. It is a malicious lie intended to make way for a government takeover of the health care system.

John Dale Dunn, M.D., J.D. teaches emergency medicine at Fort Hood, Texas and is a resident of Brownwood, Texas. He is a policy analyst for The Heartland Institute.

To read this article with all the substantiating references, please go to

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2.   In the News:  Obama’s Budget Director Orszag's Health Warning

Democrats are gearing up for a new run at heath care next year, which is another way of saying that it's an arms race to promise the most while disguising the costs, says the Wall Street Journal.  Obama's budget director, Peter Orszag was the former head of the Congressional Budget Office (CBO), and his useful work there on the unchecked growth of U.S. health spending, especially entitlements, ought to put the cost issue at the center of the 2009 debate.

According to CBO reports:

·         Government spending on Medicare and Medicaid is expected to rise to 6 percent of Gross Domestic Product in a decade, from 4.2 percent of GDP today.

·         In dollars, this amounts to $1.4 trillion -- nearly 30 percent of the entire federal budget.

·         If costs grow on pace, U.S. medical spending will rise to 25 percent of GDP in 2025, from 17 percent today.  

Adding to this looming catastrophe are plans in Congress to:

·         Expand the insurance program for children, which will cost an extra $80 billion over the next 10 years.

·         Prevent automatic cuts in Medicare reimbursement fees to physicians at a cost of $556 billion.

But those are nothing compared to the centerpiece of the universal health care agenda:  a "public option" to provide government insurance for Americans of all ages and incomes.

·         In one scenario, CBO finds that allowing the nonpoor to buy into Medicaid would cost $7.8 billion over the next decade.

·         If that sounds like pocket change, keep in mind that Democrats want to make both the public option and private insurance less expensive for beneficiaries by transferring extra costs to the government, which would cost an estimated $752 billion.

CBO also finds that programs designed to trim costs, such as health information technology or comparative effectiveness research, will produce only modest savings.

Source:  Editorial, "Orszag's Health Warning," Wall Street Journal, December 29. 2008.

For text:

For more on Health Issues:


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3.   International Medicine: A Foretaste of the Future of American Medicine?

Montreal doctor Jacques Chaoulli spent eight years representing himself all the way up to the Supreme Court where in 2005 he successfully persuaded the top court to strike down Quebec's ban on private medical insurance.

Jacques Chaoulli, hero of the proletariat

Dr Jacques Chaoulli's Supreme Court win struck a blow for the common man, according to economist Larry MacDonald's rather unusual reading of the matter, published yesterday in Canadian Business Online under the title "Lawyers: Another conspiracy against the laity?" [Canadian Medicine, November 9, 2008]

The title comes from a George Bernard Shaw quotation: "All professions are conspiracies against the laity." (Keep in mind that he also said, "Every doctor will allow a colleague to decimate a whole countryside sooner than violate the bond of professional etiquette by giving him away," and, "At present, intelligent people do not have their children vaccinated, nor does the law now compel them to. The result is not, as the Jennerians prophesied, the extermination of the human race by smallpox; on the contrary more people are now killed by vaccination than by smallpox." The US National Library of Medicine has a nice overview of vaccine hysteria, including George Bernard Shaw's role.)

Montreal doctor Jacques Chaoulli spent eight years representing himself all the way up to the Supreme Court where in 2005 he successfully persuaded the top court to strike down Quebec's ban on private medical insurance. One of his suggestions for improving the legal system: Canadian lawyers should provide consulting services for people who want to represent themselves, just like lawyers in the U.S. do (which is a lower cost alternative to direct representation).

Deborah Rhode, a Stanford law professor and leading scholar on legal ethics, argues in her book, Pro Bono in Principle and in Practice (2005), that lawyers bear an ethical duty to ameliorate "their monopoly's deleterious effects" by doing more pro bono work for those who are disenfranchised. After all, "the state-sanctioned scarcity of legal services" is the reason for their affluence, she writes.

To be fair, the problem lies not entirely with the law societies. The complexity of court procedures also contributes to delay and high costs (the Supreme Court of Canada's Web site has a section on self representation that advises: " … it is a good idea that you get a lawyer as the procedure is complicated"). It thus follows that another part of the solution would be to simplify the tangled web of court procedures.

Until fees come down, litigants can save themselves a fortune and register a vote against a cartel-like arrangement by joining the do-it-yourself trend running through other industries such as investing and real estate services. The great enabler, of course, is the Internet, which yields easy access to any Canadian statute, regulation, or case. If you have the time and dedication to do it right, success is possible, as Chaoulli demonstrated.

To read more about Dr. Chaoulli’s current legal challenges, go to 
Chaoulli back in court, but this time it's to speak about a patient's death in Canadian Medicine, December 12, 2008.

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

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

Physicians and patients owe a great debt to Dr. Chaoulli. When private health insurance is forced out of the picture in the United States, will we have a physician with Dr. Chaoulli’s courage?


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

In America, everyone has access to HealthCare at all times. No one can be refused by any hospital.

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4.   Medicare: Obama Will Ration Your Health Care

Think of his health plan as a federal HMO.  By SALLY C. PIPES

People are policy. And now that President-elect Barack Obama has fielded his team of Tom Daschle as secretary of Health and Human Services and Melody Barnes as director of the White House Domestic Policy Council, we can predict both the strategy and substance of the new administration's health-care reform.

The prognosis is not good for patients, physicians or taxpayers. If Mr. Daschle meant what he wrote in his book "Critical: What We Can Do About the Health-Care Crisis," Americans can expect a quick, hard push to build more federal bureaucracy, impose price controls, restrict medicines and technology, boost taxes, mandate the purchase of health insurance, and expand government health care. 

In his book, Mr. Daschle proposes a National Health Board to regulate the way health care is provided. This board would have vast powers in regulating the massive federal health-care system -- a system that includes Medicare, Medicaid, and other programs. Under Mr. Obama, it is likely that that system will be expanded and that new government insurance for the nonelderly, nonpoor will be created.

Given the opportunity, Mr. Daschle would likely charge the board with determining which treatments and drugs are cost effective and therefore permissible to use for patients covered by the government. And because the government is such a big player in the health-care market (46% of health-care spending comes from the government), the board would effectively set parameters for private insurers.

It is nearly certain that the process of determining which drugs and which treatments would be approved for use would be quickly politicized. The details of health-care policy may not be kitchen table conversation, but the fact that a Washington committee can deny grandma a hip replacement due to her age, or your sister a new and expensive drug, is. Health care is personal and voters will pressure lawmakers on access to care.

Liberal experts, Mr. Daschle included, believe that America needs to ration new technology and drugs. In his book, Mr. Daschle complains about overuse of new technology and praises the United Kingdom's National Institute for Health and Clinical Excellence (NICE), a rationing system that controls government costs. NICE's denial of care is legendary -- from the arthritis drug Abatacept to the lung cancer drug Tarceva. These drugs are effective. It's just that the bureaucrats don't consider them cost effective.

Americans will not put up with such limits, nor will our elected representatives. Mr. Daschle himself proves this. He punts the hard decisions about rationing to an unelected board. Yet his main proposals are not only about expanding subsidized programs to cover more people but about adding the massively expensive benefit categories of mental health, which has a strong lobby behind it, and long-term care, which is important to the broad middle class.

One of the great myths in health care is that the uninsured are responsible for driving up private premiums by shifting costs. Uncompensated care certainly shifts some costs to private payers. Yet these costs are actually quite manageable in the aggregate, akin to what retailers lose due to shoplifting. The major cost shift is from government programs -- Medicare and Medicaid -- to private plans. The government pays doctors to treat Medicare and Medicaid patients. But the rates it pays, on average, are less than the cost for providing care to these patients. This is why Medicaid patients, and increasingly Medicare patients, struggle to find doctors. Putting more people on these programs will destabilize the remaining private system and create a coalition for price and wage controls.

Americans will never tolerate this. Remember our managed-care experiment in the 1990s. It succeeded in its main goal of controlling costs without an aggregate reduction in health quality. But in asking Americans to limit their choices, it prompted a bipartisan act of Congress to provide patients with a Bill of Rights. Now Mr. Daschle proposes nothing less than a giant HMO with a federal bureaucracy setting the benefit plan.

Mr. Daschle's model is Massachusetts. But Massachusetts's plan is an unfolding disaster and demonstrates how Mr. Daschle's private/public model is merely a stalking horse for government-dominated health care.

The headline claim is that the program has signed up 442,000 more people for health insurance. The reality is that 80,000 of these were simply put on Medicaid and 176,000 more on the taxpayer-subsidized plans. Costs have exploded, requiring additional tax hikes and the entire system is only possible due to sizable transfers from the federal government. The plans are so unaffordable that in 2007, 62,000 people were exempted from the individual mandate. So much for universal coverage.

The only way the Massachusetts plan will survive is with continued and increasing federal subsidies -- that is, tax revenue from the residents of other states. The only way Mr. Daschle's proposed plan would survive is with massive deficit spending -- that is, with taxpayer money from future Americans, many of whom are not yet born.

Mr. Daschle and the Democrats have spent years developing both the policy and political strategy to make the final push for taxpayer-financed universal health insurance. They have the players on the field, a crisis providing a sense of urgency, and a playbook filled with lessons learned from years of health policy reform disasters -- most recently that of HillaryCare in 1994.

The big questions for believers in private medicine are at this point political and strategic. With employers and most insurers reportedly on board with the new administration's desire for radical overhaul, who will step in to ask the tough questions? Will these issues get raised in time to provoke a meaningful, fact-based debate? Americans could easily find that Mr. Obama's 100-day honeymoon ends with a whole new health-care regime they hadn't quite bargained for.

Ms. Pipes, president and CEO of the Pacific Research Institute, is the author of "The Top Ten Myths of American Health Care: A Citizen's Guide" (Pacific Research Institute, 2008).

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

- Ronald Reagan

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5.   Lean HealthCare: 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 study appears in the latest issue of Health Services Research.

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.

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:

Blackwell Publishing is the world's leading society publisher, partnering with 665 academic and professional societies. Blackwell publishes over 800 journals and, to date, has published more than 6,000 books, across a wide range of academic, medical, and professional subjects. For more information, Contact Sean Wagner at

Article URL:


The Future of Health Care Has to Be Lean, Efficient and Personal.

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6.   Medical Mythsisdirection in Healthcare: 98,000 people die from medical errors each year; 46 million uninsured; 18,000 die due to lack of insurance; Not one of these statements is true. –Greg Scandlen

Here's what we wrote, nine long years ago: Report on health-care errors is unsubstantiated. –Robert J Cihak, MD

Orange County Register January 23, 2000, Guest column, on page 2 of Sunday's Commentary section

Medical Diagnosis: Crying Like a Wolf?

Institutions love to cry wolf when placing blame on someone else. On Nov. 29 last year the Institute of Medicine leaked a report scaring the public with its claims that somewhere between 44,000 to 88,000 to 120,000 patients die each year because of human error.

The report was widely sensationalized by the press and TV media. It was perfect fodder for headlines or the 11 o'clock news.

Not one reporter or editorial writer anywhere challenged the assumptions of the report.

Even before this big leak, selective portions of the report were pre-leaked to the media. The press and public have not seen the whole report and therefore have not been able to assess its assumptions, methods, results, conclusions or validity.

To us, offering a range of 40,000 to 120,000 deaths is hardly precise. We also note that even the lower end of this range is three times higher than the National Safety Council estimate.

The Institute of Medicine is a private nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. In other words, it's bought and paid for by the federal government.

Not surprisingly, within a few days, as if by magic, President Clinton and Sen. Edward Kennedy had already released their plan to make patients safe again. How convenient. What fast workers they have in their little hives.

The members of the committee that created the report just happen to be professors, administrators, executives and others, all with nice-sounding titles. As hard as we looked at these impressive credentials there does not appear to be one person who is a full-time practicing physician. Sort of reminds us of Hillary Clinton's 1993 Health Care Task Force, which included hundreds of lawyers but very few practicing physicians.

If the Institute of Medicine findings are correct, the obvious solution for absolute, complete prevention of all medical errors would be very simple: just ban all medical practice in the country.

This absurd example points to the reason that most people go to the doctor and hospital in the first place - they hope to improve their condition as a result of being seen.

Part of the recommended agenda, according to the press release leak, is to create 'incentives that will lead to a safer health care system.' Their next paragraph suggests creating a new federal bureaucracy called 'A National Center for Patient Safety.'

The track record for most recent government programs is not encouraging. The motto of many politicians seems to be 'For Every Problem, There's A Program' We observe that every government program seems to create about twice as many problems as it addresses, leaving us with three problems.

Even if the pre-released numbers were correct, could government programs such as Medicare and managed care practices promoted by the government have something to do with these fatal errors?

If bureaucrats limit staffing to half as many nurses, therapists and physicians as needed to do the job right, and also limit patient encounters to eight minutes, might these bureaucratic misadventures increase medical errors?

The Institute of Medicine attempts to curry favor and support by asserting that the problem is not bad people in health care - it is that good people are working in bad systems that need to be made safer.

Searching for safety also has risks; anything done to look for safety takes resources away from something else.

Requiring medical people to spend time on additional safety questions, courses and the perpetual paperwork takes away from the time they can spend examining, diagnosing and treating patients.

Other research suggests that diverting resources actually costs lives, in that people don't preserve their own health as well when resources are taken from them and wastefully expended by others.

Several econometric and risk analysis studies estimate that one American dies prematurely for about every $10 million diverted into wasteful activities.

Until we get all the facts, and the data undergo scrutiny and analysis, perhaps we should declare a temporary moratorium on worry for the patients of this country. Although the sky may appear to be falling, in all likelihood it is not. Our modest proposal is for everyone to stop crying wolf.

In the meantime take a deep breath, hold it, exhale, and relax.

Michael Arnold Glueck, MD, a Newport Beach physician who has written extensively on medical, mental health, and medical-legal reform issues. Robert J. Cihak, M.D., Aberdeen, Wash., is health policy analyst for the Evergreen Freedom Foundation in Washington State and is president-elect of the Association of American Physicians and Surgeons (AAPS).

Copyright 1999 The Orange County Register 

Medical Errors. By Greg Scandlen

They are tragic when they occur. Certainly hospitals should be places of safety, not of peril, and hospitals need to deal seriously with issues like medication errors, preventable infections, and even mundane things like hand washing between patients. But injecting hysteria is not helpful. One commentator was quoted as saying, “The equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the U.S.”  [1] Egads.

In fact, the 98,000 figure came from a report by the Institute of Medicine, “To Err is Human.” It was the very top range of an estimate that ranged from 44,000 to “perhaps as many as 98,000” deaths. These estimates are based on exactly two studies in very localized areas that were then extrapolated to the entire population. The higher one was based on an examination in 1984 – twenty-four years ago – of 31,000 admissions in New York that found 173 patients who died “at least in part because of an adverse event,” according to a review in the Journal of the American Medical Association (JAMA)[2]. Even the definition of an “error” was suspect, being based on the opinion of three physicians who reviewed the medical records. The lead researcher of these two studies, Trowen Brennan, MD, JD, cautioned against reading too much into his results, as reported by John Dunn, MD, JD in an analysis published by the Heartland Institute. [3] The lower estimate of 44,000 deaths is based on a more recent (1992) review of hospital records in Utah and Colorado that was similarly extrapolated to the entire population.

Taken together the two studies might have raised a number of questions the IOM ignored. Such as, why the drastic difference between New York in 1984 and Colorado/Utah in 1992? The second study found a problem less than half as severe as the first one. Is medical practice so very different in the two locations? Did conditions change from 1984 to 1992? [4] <#_ftn4>  Is one population at greater risk than the other? These are provocative questions that would have intrigued a serious researcher, but the Institute of Medicine had no interest in serious research. It wanted to rush out with a scary number and did so. But projecting the one-time experience of a single locality on the entire nation has no credibility whatsoever.

Whatever else might be said about the problem of inpatient errors, one thing is certain – the guesstimate of 98,000 deaths per year is wrong. Yet the media continue to tout it.

From: On Behalf Of Greg Scandlen
Sent: Tuesday, December 23, 2008 9:41 AM
To read Greg Scandlen’s column, go to, Consumers Power Reports.



Well Meaning Regulations Worsen Quality of Care.

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7.   Overheard on Capital Hill: The President Reads A Book A Week

Bush Is a Book Lover: A glimpse of what the president has been reading. By KARL ROVE, WSJ

With only five days left, my lead is insurmountable. The competition can't catch up. And for the third year in a row, I'll triumph. In second place will be the president of the United States. Our contest is not about sports or politics. It's about books.

It all started on New Year's Eve in 2005. President Bush asked what my New Year's resolutions were. I told him that as a regular reader who'd gotten out of the habit, my goal was to read a book a week in 2006. Three days later, we were in the Oval Office when he fixed me in his sights and said, "I'm on my second. Where are you?" Mr. Bush had turned my resolution into a contest. 

By coincidence, we were both reading Doris Kearns Goodwin's "Team of Rivals." The president jumped to a slim early lead and remained ahead until March, when I moved decisively in front. The competition soon spun out of control. We kept track not just of books read, but also the number of pages and later the combined size of each book's pages -- its "Total Lateral Area."

We recommended volumes to each other (for example, he encouraged me to read a Mao biography; I suggested a book on Reconstruction's unhappy end). We discussed the books and wrote thank-you notes to some authors.

At year's end, I defeated the president, 110 books to 95. My trophy looks suspiciously like those given out at junior bowling finals. The president lamely insisted he'd lost because he'd been busy as Leader of the Free World.

Mr. Bush's 2006 reading list shows his literary tastes. The nonfiction ran from biographies of Abraham Lincoln, Andrew Carnegie, Mark Twain, Babe Ruth, King Leopold, William Jennings Bryan, Huey Long, LBJ and Genghis Khan to Andrew Roberts's "A History of the English Speaking Peoples Since 1900," James L. Swanson's "Manhunt," and Nathaniel Philbrick's "Mayflower." Besides eight Travis McGee novels by John D. MacDonald, Mr. Bush tackled Michael Crichton's "Next," Vince Flynn's "Executive Power," Stephen Hunter's "Point of Impact," and Albert Camus's "The Stranger," among others.

Fifty-eight of the books he read that year were nonfiction. Nearly half of his 2006 reading was history and biography, with another eight volumes on current events (mostly the Mideast) and six on sports.

To my surprise, the president demanded a rematch in 2007. Though the overall pace slowed, he once more came in second in our two-man race, reading 51 books to my 76. His list was particularly wide-ranging that year, from history ("The Great Upheaval" and "Khrushchev's Cold War"), biographical (Dean Acheson and Andrew Mellon), and current affairs (including "Rogue Regime" and "The Shia Revival"). He read one book meant for young adults, his daughter Jenna's excellent "Ana's Story."

A glutton for punishment, Mr. Bush insisted on another rematch in 2008. But it will be a three-peat for me: as of today, his total is 40 volumes to my 64. His reading this year included a heavy dose of history -- including David Halberstam's "The Coldest Winter," Rick Atkinson's "Day of Battle," Hugh Thomas's "Spanish Civil War," Stephen W. Sears's "Gettysburg" and David King's "Vienna 1814." There's also plenty of biography -- including U.S. Grant's "Personal Memoirs"; Jon Meacham's "American Lion"; James M. McPherson's "Tried by War: Abraham Lincoln as Commander in Chief" and Jacobo Timerman's "Prisoner Without a Name, Cell Without a Number."

Each year, the president also read the Bible from cover to cover, along with a daily devotional.


What is Congress Really Saying?

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8.   What's New in US Health Care: Creating Lean Healthcare. May 3, 2007, by Jim Womack

Ten years ago this month I made a visit to the Mayo Clinic’s large medical complex in Rochester, Minnesota. I was not there as a patient. Instead I was a sort of lean anthropologist. I was making my first foray into a major medical organization to examine its thought process and behavior from a lean perspective.

The trip was arranged by Dr. Don Berwick, the founder and president of the Institute for Healthcare Improvement in Boston, who had just convinced me that I should start LEI as a replacement for my former home at MIT. Don asked me to ponder a simple question: How would a major medical system go about implementing lean thinking across all of its activities? (As Don put it, “In healthcare we have no Toyota to copy. We don’t even have a Yugo. So where do we start?”)

As always, I took a walk. Over two days I followed a number of patient pathways as well as pathways for medical supplies, patient schedules, and specimens going through the laboratories. (Lean Thinkers often call these pathways value streams.) And I soon reached a diagnosis: Severe sclerosis of patient and support pathways.

At Mayo (and in the many medical organizations I have visited since), I found brilliant doctors who were point optimizers, focusing solely on their narrow activity without much thought (or patience) for how it meshed with the other activities around them. The hospital’s administrators, by contrast, were asset optimizers, trying to keep every expensive machine, hospital room, and specialist busy, even if this meant delays for patients and heavy burdens for staff. The nurses were the members of the organization thinking about patient pathways and about core support processes like handling supplies and drugs. But they were doing this intuitively and reactively to somehow keep things moving. They lacked recognition of the importance of their task and a rigorous methodology.

Together, the brilliant doctors, diligent administrators, and long-suffering nurses were providing healthcare that cost too much, took too long, and often produced less than optimal outcomes. To make a lean leap everyone in the organization would need to change their way of thinking and acting.

My prescription was very simple: Identify all major patient pathways as well as support streams. Map them from end to end. Then ask how each pathway can be cleared of its blockages, backflows, and cul-de-sacs for the benefit of the hospital, its staff, and its patients. Finally, and most important, ask what changes in organizational lifestyle will be required to keep the pathways clear.

What troubled me was not the diagnosis or the prescription. I was pretty sure I was right. What I worried about was the prognosis.  My recommendations would require everyone—doctors, nurses, and administrators (and suppliers too) -- to change their behavior and organizational lifestyle. And as medical professionals know, lifestyle change is usually the hardest part of any treatment.

Given the difficulties involved, I ended my first venture into healthcare in May of 1997 thinking it was premature to hope for much progress toward lean healthcare. And I didn’t return to Mayo for ten years until last week when I spent a day with Dr. Henry Ting, a cardiologist with a natural instinct for process thinking. We looked carefully at the work his team has done recently to speed patients from the point they suspect they might be having a heart attack—usually far from a hospital—to the point where all appropriate treatments have been applied.

The results are quite dramatic. Rethinking this pathway saves lives—many lives—because the more quickly appropriate treatments are applied the more likely the patient is to survive and to survive without major heart damage. And here’s the really encouraging news: A lean pathway reduces costs for the hospital and makes life better for the staff. It’s a win-win-win. My skepticism on my previous visit was replaced with hope after this visit.

But I also realized while flying home that Dr. Ting’s team had performed a brilliant procedure on one of the easier problems to fix and sustain. They had analyzed a single pathway and one where the value of saving time is so overwhelmingly obvious that any medical organization will find it hard not to change its behavior once the sclerotic state of the existing pathway is clearly revealed. (Fortunately, their work is now being successfully paralleled throughout Mayo’s cardiology practice and by similar pioneers along other pathways in many healthcare organizations across the world.)

The hard part for all of us is to tie together these pioneering, single-pathway efforts—which seemed beyond our grasp only 10 years ago. We need to create a complete lean enterprise in which all pathways have been permanently cleared and the lifestyle of the organization has been changed as well. This will require more than lean techniques. It will require new management methods and a new type of leadership.

Given the urgent need for this lean leap, I’m truly delighted that my long-time co-author Dan Jones has taken on the challenge of asking what a truly lean healthcare system will look like. He is leading the first Global Lean Healthcare Summit in the UK at the end of June in which we will be asking what kind of leadership and what kind of management will be required. . .

So I’m deeply encouraged that Lean Thinkers in the healthcare community are at last tackling the world’s most important value streams. But I’m also concerned that we will stop short with single pathway interventions. And I’m worried that improvements in individual pathways can’t be sustained because the organizations in which they reside have not changed. What the patient—the whole healthcare system—really needs is to think through the entire system from a management and leadership perspective so we can truly create and sustain lean healthcare.

Jim Womack, Chairman and Founder, Lean Enterprise Institute

To read the entire article, go to

To read more of Jim Womack’s E-letters, go to


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9.   Health Plan USA: Networking to Develop the Ideal HealthPlan for the USA

HealthPlanUSA is the network concerned with bringing the best available ideas to a unified HealthPlan concept that will help resolve the health care problems in the United States. (Since we have many readers in the UK, Europe, India, Chile, and Canada,,,,, and others will be launched later in 2009 and 2010.) Once every quarter, we review the progress of the ideal HealthPlan for the USA that will make HealthCare more affordable for all Americans and their employers, if an employee benefit exists.

Thank you for joining the Medical/Professional/Business/InfoTech Gatherings on the FirstTuesday of each quarter.

The Major Current Problems in HealthCare

The $2.4 trillion health care industry is the only major segment of the economy that is failing, and there is nothing the employer, insurance carrier or government can do about it.

Health care is the only product or service (outside of public education) that has consistently grown worse over the past 40 years, with decreasing customer (patient) satisfaction. Every other product and service in our economy has improved in quality and grown less expensive over time, with increasing customer satisfaction.

Health care is the only sector of the economy where prices have been steadily increasing since the end of WWII. Every other sector of the economy is reaping the benefits of Moore’s Law, which states that the cost of digital technology decreases by 50 percent every 18 months. In health care, it is the reverse—less efficient and more costly. For instance, although the Length of Stay (LOS) for delivery of a child has decreased from four or five days to one or two days, the hospital cost has more than doubled. The LOS for gallbladder surgery has decreased from five days to one day, but the hospital cost has doubled. The surgeons' fees have remained level or even decreased during this time.

The HealthPlanUSA Solution

HPUSA is the only true Market-based Health Plan that uses the Internet and Digital Information Technology to bring the Insurance Carrier, Service Providers (Hospitals, Surgi-centers, Physicians, Pharmacies, Diagnostic and Treatment Centers), Patients and Credit Providers together at the same interface, allowing data, information and fund transfers to occur in real time.

The patient takes an interest in making an informed decision at every step of the health care process when he or she has a financial obligation in all decision-making processes–which doctor to see, which hospital to use, which pharmacy to utilize, which laboratory to use for testing, which x-ray facility for diagnostic testing, which therapist to use for physical, occupational or speech therapy. The financial stake is proportional to the cost incurred without limit. Thus, in turn, each service provider will provide the best service for the fee involved in order to assure a continuing customer (patient) base.

The Benefits

·         Healthcare costs are reduced making it more affordable and available to all Americans, thus eliminating the uninsured concerns.

·         Quality is increased by cutting down delays in patient care, thus decreasing unnecessary patient suffering and premature death.

·         Spectrum of a customer market base is increased to insurance and credit providers by the direct digital interface with the patient and service providers.

·         Efficiency is increased by cutting the time between providing medical services and payment to service providers: hospitals, surgi-centers, physicians, pharmacies, laboratories for x-ray, CTs, MRIs, and other diagnostic and treatment centers. Secondary and tertiary billing, denial of service and further billing has been relegated to the dustbin of history. This duplicative and triplicate cost is difficult to ascertain because currently this cost is difficult to document or analyze, is not available, is not transparent, or is hidden. Actuaries that are working for large health insurance companies have informally estimated that this will be a 30-50 percent decrease in business office costs for hospitals, physicians and other providers.

·         Choice is unlimited as patients make their own choice on the basis of cost, quality and efficiency. Unless they improve, inferior or incompetent providers will be eliminated more efficiently by the simple procedure of changing providers. This will be more effective than any HMO, insurance plan, PEER Review, government program, Medical Board or other overseeing or policing agency can provide, thus saving multiple bureaucratic costs which further decreases health care costs. Patients monitoring their own health care costs is the most effective, and sometimes even ruthless, cost deterrent. Inferior providers are simply eliminated due to lack of patients and are forced to look for other employment. Some insurance actuaries have informally admitted this could eliminate up to 90 percent of current quality assurance costs.

·         The cost becomes extensive due to provider panels, provider credentialing, the army of nurses and reviewers looking over every hospital admission - reviewing charts daily, controlling every consultation or diagnostic procedure, controlling outpatient consultations and patient evaluations, reviewing and authorizing or denying every surgical procedure, reviewing every CPT and ICD 9 code, and reviewing patient charts for adequacy. Although accurate data is elusive, some actuaries have informally estimated a profound decrease in administrative and bureaucratic cost approaching 80 percent of current surveillance costs.

·         The nation's $1 trillion privately funded health care costs (of the $2.4 trillion total) will be significantly reduced. Although accurate data is inconclusive, conservative estimates by actuaries suggest the nation's health care costs should be reduced by at least thirty to forty percent, making health care affordable to all Americans that fall between the Medicaid and Medicare programs. As Medicare goes bankrupt and eliminates 66 and 67 year olds, progressing higher as it follows social security benefit restrictions, HealthPlanUSA will easily be able to absorb these unfortunate Americans who have lost an unrealistic unfunded coverage base.

·         With patients involved and monitoring their own health care with direct access to all their lab work, x-rays, procedures and medical reports, liability will plummet. Malpractice insurance will drop at least 50 percent within one year of experience and for medical specialists, it will be on the order of their car liability or house, fire, earthquake and flood insurance. This will be a huge savings for physicians and other service providers.

Welcome to an Exciting Journey

We appreciate your participation as we step back each quarter to reflect on where health care has been and just what the ideal HealthPlan might be for the USA and any country wanting to privatize and personalize their HealthCare. As we discuss various issues in our attempt to understand the health care problems for Americans, we welcome your thoughts and ideas in our efforts to create the ideal HealthPlan for the United States and the world. The subject is huge. Although the email response has been overwhelming, we do look over every email and all of your ideas and suggestions will help formulate the future of our country. We will also have a blog link for your direct participation and dialog located on our header.

If you would like to participate or be an investor in an innovative health plan for our country’s future, please send a personal email with your business and professional qualifications to or

            © Del Meyer, MD 1/2009

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Current Issues Being Studied

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

Medicine and Liberty - Network of Liberty Oriented Doctors, Alphonse Crespo, MD, Executive Director and Founder

·                     We support professional autonomy for doctors and liberty of choice for patients

We uphold the Hippocratic covenant that forbids action harmful to the patient

We defend responsible medical practice and access to therapeutic innovation free from bureaucratic obstruction

We work towards a deeper understanding of the role and importance of liberty & market in medical services

MedLib is part of a wide movement of ideas that defends

the self-ownership principle & the property rights of individuals on the products of their physical and intellectual work

free markets, free enterprise and strict limits to the role of the State

·                     Medicine and Liberty - Network of Liberty Oriented Doctors,, Alphonse Crespo, MD, Executive Director and Founder
Medicine & Liberty (MedLib) is an independent physician network founded in 2007, dedicated to the study and advocacy of liberty, ethics & market in medical services.
  - We support professional autonomy for doctors and liberty of choice for patients
 - We uphold the Hippocratic covenant that forbids action harmful to the patient
 - We defend responsible medical practice and access to therapeutic innovation free from
  bureaucratic obstruction
 - We work towards a deeper understanding of the role and importance of liberty & market in
 medical services
MedLib is part of a wide movement of ideas that defends
   - the self-ownership principle & the property rights of individuals on the products of their
physical and intellectual work
   - free markets, free enterprise and strict limits to the role of the State

·                     Americans for Tax Reform,, Grover Norquist, President, ke of Americans for Tax Reform,, keeps us apprised of the Cost of Government Day® Report, Calendar Year 2008. 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 2008 was July 16th, a four-day increase above last year's revised date of July 10th. With July 16th as the COGD, working people must toil on average 197 days out of the year just to meet all the costs imposed by government. In other words, the cost of government consumes 53.9 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.

·                     National Taxpayer's Union,, Duane Parde, 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

·                     FIRM: Freedom and Individual Rights in Medicine,, Lin Zinser, JD, Founder,, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance.

·                     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 Op-Ed articles, some of which you and I may disagree on, go to

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Thank you for joining the HealthPlanUSA network of 80,000 professionals that receive our newsletter and visit our websites. Stay tuned for the latest innovating thinking in HealthCare and have your friends do the same.Stay Tuned to the HealthPlanUSA Networks and have your friends do the same.

Articles that appear in HPUSA may not reflect the opinion of the editorial staff. Sections 1-5 are entirely attributable quotes in the interest of the health care debate.

Editorial comments are in brackets.

PLEASEALSO NOTE: HealthPlanUSA receives 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.

Spammator Note: HealthPlanUSA uses many standard medical terms considered forbidden by many spammators. We are not always able to avoid appropriate medical terminology in the abbreviated edition sent by e-newsletter. (The Web Edition is always complete.) As readers use new spammators with an increasing rejection rate, we are not always able to navigate around these palace guards. If you miss some editions of HealthPlanUSA, you may want to check your spammator settings and make appropriate adjustments. To assure uninterrupted delivery, subscribe directly from the website rather than personal communication:


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Del Meyer

Del Meyer, MD, CEO & Founder

Satyam A Patel, MBA, CFO, & Co-Founder

HealthPlanUSA, LLC

6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608


Words of Wisdom & Reality

Othello: “Our bodies are gardens and our minds are the gardeners.” –William Shakespeare

Congressman: I run an organization that’s billions in debt. I may be incompetent, but I won’t give up any perks and pay like those losers in the auto industry. In fact, I’ve given myself a raise.  –Kirk Walters, The Toledo, Ohio Blade.

"The environment you fashion out of your thoughts, your beliefs, your ideals, your philosophy is the only climate you will ever live in." — Dr. Stephen Covey: Personal development author, speaker, consultant.


Some Recent HeadlinesPostings

One Woman's Trash Is Another Woman's...Lingerie?

Falling prices for recyclables has resulted in a glut of garbage. And that's good news for the artists who transform cast-offs into commodities.

 Photos: Searching for Treasure Trove of Trash

 Video: Recycled Paper Prices Get Snipped Away

As Salt Prices Rise, Frozen Towns Reach for Molasses

Green Revolution Hits Dead End In Georgia Cemetery Proposal. Elizabeth Collins, a gardener, birdwatcher and a self-described "renaissance woman," wanted to start a "natural" cemetery where bodies would be buried without embalming, coffins or vaults. Ms. Collins Thought Natural Burials Were a Killer Idea; Locals Saw Grave Threat.


This DateMonth in History – January 1

January 1st is the day when resolutions and hope are put to the test. Will it be a day of good intentions and a journey of triumph for good? Or will it just be another year in our lives? Lincoln issued his Emancipation Proclamation on this date in 1963. Brooklyn merged with New York in a single city in 1898. Twenty-six nations signed the United Nations Declaration in World War II in Washington, D.C. in 1942. It is also the birthday of Paul Revere (1735), Betsy Ross (1752), and General Anthony Wayne (1745). College Football Bowl games could no longer all be played on this day as the number grew from the original four to more than twenty, taking most of the week to complete. The first successful heart transplant operation was performed in South Africa on Jan 2, 1968. The first successful appendectomy was performed in Iowa on Jan 4, 1885. On this date in 2005, President Bush resolved to read one book a week and did read one every 5 days. He also continued to read the Bible completely through every year. Maybe we should all resolve to match our outgoing President in his resolutions so successfully completed. That would make all of us better individuals, improve our education level, and make our country a better place in which to live. Best wishes for a Joyous and Exciting New Year.  –Del Meyer, 2009