Community For Affordable Health Care

     Vol V, No 3, October, 2006


Utilizing the $1.5 Trillion Information Technology Industry

To Transform the $1.8 Trillion HealthCare Industry into Affordable HealthCare


In This Issue:            

1.         Featured Article: Capitalism: The Movie

2.         In the News: The Population Boon; 300 Million and Growing

3.         International Medicine: Germany to Postpone Health-Care Changes by Three Months

4.         Medicare: California’s Governor Vetoes Measure for Universal Health Care

5.         Lean HealthCare: Lean Consumption, by James P. Womack and Daniel T. Jones

6.         Medical Myths: We Can’t Provide Health Care to 300 Million Americans?

7.         Perspectives on Capital Hill: The White House May Be Losing the Veterans Support

8.         What's New in US Health Care: The Intersection of High Tech and Total Health

9.         Health Plan USA: Free Market in Health Care -A Work in Progress

10.      Restoring Accountability: in Medical Practice, Insurance and Government Programs

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1.         Feature Article: Capitalism: The Movie,  The Atlantic Monthly, March 2006

The Agenda: First Principles: Capitalism: The Movie:

Why Americans don’t value markets enough—and why that matters by Clive Crook

Capitalism is not much loved, even in the parts of the world it has served best. If only one country were to dote on free enterprise, America surely ought to be it. With world-beating companies, breast-beating CEOs, a timid political Left, dwindling and unpopular labor unions, and extreme prosperity (by international standards), one might expect the prevailing climate of opinion to be ardently pro-capitalist. But no. American enterprise has its spokesmen, brasher than most, just as it has its critics, as fierce as any. In the main, however, when intelligent Americans with no axes to grind contemplate the market economy, they are neither angry nor adoring, just wary and distrustful. It was ever thus.

Seen a movie lately? Watched television or read a newspaper? The culture that speaks to Americans, and hence to the Western world, radiates suspicion of free enterprise—cordial and restrained, as a rule, but dubious nonetheless. Yes, the system does work, says this culture, and there appears to be no alternative. But what a shame this is, it continues, because capitalism rewards our worst and most selfish instincts. “Greed is good” may stock the shelves, but is somewhat less than inspiring.

Popular culture understands that the market economy creates material prosperity, albeit for some more than others. It seeks out and worships business celebrities. But at the same time it sees the system as spiritually—and politically—corrupting. As viewed from Hollywood, workers are usually downtrodden, bosses are usually grasping, consumers are usually gulled, and shadowy global finance is always calling the geopolitical shots. We manage to prosper, most of us, but this system of ours is not very noble.

What is most striking, so far as the movies’ treatment of capitalism goes, is not the hostility of films whose main purpose is actually to indict corporate wickedness. . . It is the idea of routine, reckless corporate immorality—maintained as though this premise were inoffensive, uncontroversial, and hardly worthy of comment—that drives movies whose principal interest lies elsewhere, whether in the human drama of contemporary geopolitics. . . 

The point is not that such movies, or the culture more generally, argue that capitalism is evil. Just the opposite: it is that they so often merely assume, innocently and expecting to arouse no skepticism, that capitalism is evil.

In this, of course, the culture is not really driving attitudes. It is expressing widely held (though not very closely examined) beliefs; it is itself responding to demand. And disenchantment with commerce goes back an awfully long way. Samuel Johnson was already confronting an age-old tradition 250 years ago when he said, “There are few ways in which a man can be more innocently employed than in getting money.” So was Adam Smith, shortly after, when he wrote, “It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.” Smith was not praising selfishness, by the way; he did not believe that greed is good. He was explaining how commerce can spontaneously harness a base worldly instinct to an enlightened social purpose—an idea that people, one Industrial Revolution later, still find implausible.

Capitalism is prey to excesses, self-evidently, and it creates, or leaves unattended, a host of problems that decent societies must address by other means. Even so, the prevailing culture of suspicion and disappointment is at odds with the facts. Mainly, what is missing is awe. Premodern scholars (Karl Marx is an exception) could scarcely have imagined the material advance that capitalism has delivered. Certainly Adam Smith never dreamed that his “invisible hand” would arrange things so well.

In the late 1980s, as Mikhail Gorbachev embarked on his perestroika program of economic reform, Soviet officials were sent abroad to see how things were done in the West. One visited London’s main vegetable market. He asked how the market was organized, and how prices were set. He was told that the individual traders bought whatever quantities they wished, and set their own prices, and that these fluctuated throughout the day as the balance of supply and demand changed. At this, the Soviet visitor laughed. He said he understood that this was the official line—but, please, how did the market really set prices?

That, in fact, was the reaction of an intelligent man. It is fantastically improbable that markets work, at scale, as well as they do. It is astonishing that in an economy of America’s size—to say nothing of the world economy as a whole—a limitless variety of goods and services is continuously offered at prices people are willing to pay, without persistent gluts or shortages, entirely without central direction. That the system also calls forth an endless flow of innovation and improvement is a miracle. The man from Moscow was right to be incredulous.

And it gets better, because this infinitely complicated, decentralized system has an obvious affinity with personal liberty, in a way that a centrally directed system never could. Market exchange, after all, is voluntary; under central planning, you are told what to do—or else. Europe’s newcomers from the former Soviet empire need no reminding of this. But people in Western Europe and the United States, who never had to endure the alternative to a market economy, see little or no force in the connection between economic and political liberty. Often it seems that those in the West who are most concerned with defending political or civil freedoms are least concerned with the economic kind, even to the point of being outright opposed to them. They argue as though political freedom is the real thing, whereas economic freedom is merely a cloak for injustice. In the end, as socialism in practice showed, the two are indivisible.

But does it matter, really, if people are less comfortable with the idea of capitalism than they might be, or should be? Up to a point, to be sure, this skepticism serves a purpose, drawing attention to ills and injustices that might otherwise be ignored. But there is a cost: the mood of discomfort and suspicion is a pity in itself, to the extent that it is unwarranted. Also, it fosters a demand for, or tolerance of, frivolous or wasteful interventions by government.

In comparison with other rich countries, America tends to think of itself as lightly taxed and lightly regulated. This is an illusion. Taxes in America are admittedly lower than in most of Europe—though this is partly because the Bush administration is borrowing so much (a state of affairs that cannot last), and partly because the United States, unlike almost every other rich country, has not fully socialized its health-care system. Even making no allowance for health expenditures, the government currently absorbs about as much of the national income (37 percent) as in Australia (36 percent), Canada (40 percent), Ireland (36 percent), Japan (37 percent), Spain (39 percent), and Switzerland (37 percent), and none of these is regarded as a champion of free-market economics. America regulates its labor market more lightly than Europe, hence its low rate of unemployment; but in many other areas, especially so far as risk, product safety, and the environment are concerned, America’s economy is at least as heavily regulated as those in Europe. . .

It is difficult to see where any heightened appreciation of the market system is going to come from. Economists, presumably, ought to be supplying it. Unfortunately, in most cases, communicating a sense of wonder is not among their gifts. In some ways, teachers of economics are probably making matters worse. As practiced in universities, economics continues to turn inward, with ever more emphasis on math, quantitative methods, and narrow specialization. You can make a case for that, but it silences the discipline on the thing that matters most. Also, people are suspicious of economists: they see them as agents of a suspicious doctrine. And it so happens that a variety of studies have shown, notoriously, that training in economics inclines people to be more “rational”—that is, more selfish and less inclined to cooperate. This does not commend economics to the rest of us.

Corporate leaders and right-of- center politicians who set up as spokesmen for free enterprise are worse. They speak of capitalism’s virtues, then get down to the real business of subsidies, import protection, tax relief, and other favors. People see through it, and find their prejudices confirmed. The conflation of the interests of business with the interests of the nation is virtually an organizing principle of the Right. Yet in reality those interests are usually opposed—as Adam Smith again pointed out. What best serves a nation’s economic interests is competition—it’s why markets work, when they do. But competition hurts individual businesses, and most CEOs hate it. Don’t look there for intellectual enlightenment.

How about a movie in which a firm prospers under threat of competition by selling things that people want at an affordable price, paying its workers the market wage, and breaking no laws, thereby advancing the common good? Well, you see the problem.

To read the entire article, the URL for this page is

And so, my fellow Americans, ask not what your country can do for you -- ask what you can do for your country.

John F Kennedy

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2.         In the News:  The Population Boon, WSJ Editorial,  October 21, 2006

"How will we house the next hundred million Americans? . . . How will we educate and employ such a large number of people? How will we provide adequate health care when our population reaches 300 million?"                               -- President Richard Nixon, 1969

President Nixon didn't live to see his questions answered, but this week the U.S. population surpassed the 300 million mark. And surprisingly, given the tenor of the reaction to the last hectomillion milestone, reached in 1967, the 300 millionth American was not greeted with the same wailing and gnashing of teeth as the 200 millionth. Call it progress.

Around the time the country's population hit 200 million, biologist Paul Ehrlich, always good for a bit of doom and gloom, compared "America's pride in her growing population . . . to a cancer patient's pride in his expanding tumor," according to Time magazine. Stewart Udall, a former Secretary of the Interior, thought 100 million sounded like a better number than 200 million. Messrs. Ehrlich and Udall are still among our 300 million, but their population bomb has conspicuously failed to explode, which may go some way toward explaining why, in the popular imagination at least, this week's milestone did not prompt widespread anxiety about the future. . .

At bottom, the debate over population revolves around a single question: Are human beings a burden, or a resource? The former view is embodied by the Ehrlich and Nixon quotes above. More bodies mean more mouths to feed, house and provide for. At a certain point, in this perspective, you run out of stuff.

The latter view holds that people don't just consume things. They make them too. More bodies mean more minds, more innovation, more dynamism and more progress. The history of the world as America went from 100 million or 200 million to 300 million lends a lot more support to the humans-as-resource view than the humans-as-burden view. In the middle of the last century, the fathers of the population-control school of thought warned darkly that when world population reached seven billion, the "carrying capacity" of the planet would be reached. Mass starvation and political upheaval would be the inevitable result. Well, we're getting right up there, but the bread lines are getting shorter, not longer.

Simply put, the reason is prosperity. For decades, economic growth has easily outstripped population growth, giving the U.S., and much of the rest of the world, both more people and more prosperity, something presumed to be impossible by the Malthusians. Meanwhile, the slowdown in population growth brings a whole new set of challenges. To meet them, America and the world will need more minds generating new ideas. Four hundred million, here we come.

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

The United States: 300 Million and Growing, WSJ, October 21, 2006, THE MAIN EVENT

The official U.S. population count topped 300 million this past week, driven largely by a robust birthrate, longer life expectancy and high levels of immigration.

Population growth is projected to continue and reach 400 million in 37 years. At current growth rates, the U.S. population will double in 70 years.

That is in stark contrast with many other developed countries. Italy, Russia and Japan are among the countries that are expected to experience population declines. Even China's population is expected to begin declining in 2030. Meanwhile the population of many developing countries is expected to triple by 2050, including Afghanistan, Burundi and Niger. . .

A look behind the growth:

Growing Population: Population growth is determined by three factors: births, deaths and immigration. Americans have among the highest birth rates in the developed world -- 14 births for every 1,000 people each year. Also, modern medical technology has allowed the mortality rate to fall to roughly eight deaths per thousand people annually. In comparison, Germans have eight births and 10 deaths per 1,000 people annually.

Aging: While the population is growing, the makeup of that population is changing. Today's elderly population is the largest it's ever been. People aged 65 and older currently account for 12% of the population. By 2050 that will be closer to 21%.

To read the entire report (subscription required), please go to

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3.         International Medicine: Germany to Postpone Health-Care Changes By Three Months, WSJ, By ANDREA THOMAS, September 8, 2006


BERLIN -- Chancellor Angela Merkel's government will postpone controversial changes to Germany's health-care system by three months to April 1, Deputy Chancellor Franz Müntefering said.

"The coalition parties are currently working on turning the agreed key points into a draft bill," Mr. Müntefering told rbb-Inforadio. "There are some points which are very detailed and that have yet to be tackled."

The reform has proved to be unpopular with the German public as it proposes cuts in spending at the same time as increases in contributions.

In July, the cabinet approved plans to raise the current 13.3% average insurance premium by around 0.5 percentage point from next year, while using tax funds to partly pay for children's health insurance from 2008. The Finance Minister has said it is still unclear where the tax money should come from to pay for the children's insurance premium.

Write to Andrea Thomas at

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

--Canada’s Supreme Court

In a State Economy, just being in line, even if it’s not going anywhere, gives a feeling of security.

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4.         Medicare: Governor vetoes measure for universal health care, by Clea Benson Sacramento Bee, September 23, 2006

Gov. Arnold Schwarzenegger on Friday vetoed a bill that would have created a universal health care system run by the state.

Senate Bill 840, written by state Sen. Sheila Kuehl, D-Santa Monica, would have abolished the role of private insurance companies in health care. Instead, the state would have covered everyone. Theoretically, the system would have been financed by taxes on individuals and businesses that would have replaced the health premiums that both now pay to private insurers. Doctors and hospitals would have remained private.

Schwarzenegger said two weeks ago that he intended to veto the measure.

In his veto message Friday, the Republican governor said government-run health care was not a solution. About 6 million Californians are uninsured.

"I want to see a new paradigm that addresses affordability, shared responsibility and the promotion of healthy living," Schwarzenegger wrote. "Single-payer, government-run health care does none of this."

In a statement, Kuehl said she was disappointed by the veto. "The reasoning behind the governor's opposition to universal health care is truly inaccurate, which is no surprise considering he has refused to meet to discuss the issue."

-- Clea Benson, Bee Capitol Bureau

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

- Ronald Reagan

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5.         Lean HealthCare: Lean Consumption, by James P. Womack and Daniel T. Jones

This article is a preview of the next leap in lean thinking described in the forthcoming book by James P. Womack and Daniel T. Jones

[We have featured Lean Production previously as a model for health care. In this article, we feature Lean Consumption as it could relate to health care. Where “service provider” is used, think physicians and the health care team. Where “customer” is used, think of the patient and his or her perspective on their needs. Where “retailer” is used, consider the hospital and surgicenter role. Lean health care is coming. Let’s make it work for everyone.]

Over the past 20 years, the real price of most consumer goods has fallen worldwide, even as the variety of goods and the range of sales channels offering them have continued to grow. Meanwhile, product quality—in the sense of durability and number of delivered defects—has steadily improved.

So, if consumers have access to an evergrowing range of products at lower prices, with fewer lemons, and from more formats, why is consumption often so frustrating? Why do we routinely encounter the custom-built computer that refuses to work with the printer, the other computers in the house, and the network software? Why does the simple process of getting the car fixed require countless loops of miscommunication, travel, waiting, and defective repairs? Why does the diligent shopper frequently return from a store stocking thousands of items without having found the one item that was wanted? And why is this tiresome process of consumption backed up by help desks and customer support centers that neither help nor support? In short, why does consumption—which should be easy and satisfying—require so much time and hassle?

It doesn’t have to—and shouldn’t. Companies may think that they save time and money by off-loading work to customers, making it the customer’s problem to get the computer up and running, and wasting the customer’s time. In fact, however, the opposite is true. By streamlining the systems for providing goods and services, and making it easier for customers to buy and use them, a growing number of companies are actually lowering costs while saving everyone’s time. In the process, these businesses are learning more about their customers, strengthening consumer loyalty, and attracting new customers who defect from less user-friendly competitors.

What these companies are doing has a familiar feel: Just as businesses around the world have embraced the principles of lean production to squeeze inefficiency out of manufacturing processes, these innovative companies are streamlining the processes of consuming. In the early 1990s we popularized the term

lean production to describe the ultra-efficient process management of our exemplar firm, Toyota. We believe it is now time to recognize lean consumption as its necessary and inevitable complement.

 “But surely,” you say, “when it comes to consumption, less can’t be more.” Actually it can be, for both consumer and provider. Lean consumption isn’t about reducing the amount customers buy or the business they bring. Rather, it’s about providing the full value that consumers desire from their goods and services, with the greatest efficiency and least pain. 

The key word here is “process.” Think about consumption not as an isolated moment of decision about purchasing a specific product, but as a continuing process linking many goods and services to solve consumer problems.  When a person buys a home computer, for example, this is not a onetime transaction. The individual has embarked on the arduous process of researching, obtaining, integrating, maintaining, upgrading, and, finally, disposing of this purchase. For producers and providers (whether employees, managers, or entrepreneurs), developing lean consumption processes requires determining how to configure linked business activities, especially across firms, to meet customer needs without squandering their own—or the consumer’s—time, effort, and resources.

The way to do this is to tightly integrate and streamline the processes of provision and consumption. The challenge is not simply logistical: Lean consumption requires a fundamental shift in the way retailers, service providers, manufacturers, and suppliers think about the relationship between provision and consumption, and the role their customers play in these processes. It also requires consumers to change the nature of their relationships with the companies they patronize. Customers and providers must start collaborating to minimize total cost and wasted time and to create new value. 

That may seem like a doubtful proposition.  But some companies—along with their customers—have started the culture shift that will make lean consumption possible. And they’re finding that everybody wins.

Why Lean Consumption Now?

While lean consumption would be a sensible idea in any era, we see several convergent trends that we think make it inevitable and, indeed, a competitive necessity now. 

With the regulated economy steadily contracting, consumers have a broader range of decisions to make, from how to invest retirement funds, to what telecommunications provider to use, to what airline to fly at what price.  At the same time, they must cope with a growing profusion of choices as producers relentlessly customize their offerings, pursue product niches, and increase their sales channels. 

In this demanding environment, information technology is steadily blurring the distinction between consumption and production.  Consumers are doing increasing amounts of unpaid work on behalf of providers, such as entering data into Web-based order forms and tracking the progress of their own orders. And these consumers are spending more and more time and energy to obtain and maintain the computers, printers, PDAs, and other technological tools needed to solve routine problems—for themselves and for providers.

This growing burden on consumers might be sustainable if not for the changes consumers themselves are undergoing. Household configurations in every advanced economy are transforming in ways that create additional time pressures and energy drains. Two-wageearner and single-parent households, where no one has time to manage consumption, are increasingly common; and aging populations are confronted with an expanding array of choices but have declining energy to address them. 

Collectively, these trends give rise to the consumer’s emerging dilemma of more choices to make and products to manage with decreasing time and energy. Yet the situation also creates a major opportunity for providers.

The Principles of Lean Consumption

The concepts underlying lean consumption boil down to six simple principles that correspond closely with those of lean production.

1.         Solve the customer’s problem completely by insuring that all the goods and services work, and work together.

2.         Don’t waste the customer’s time.

3.         Provide exactly what the customer wants.

4.         Provide what’s wanted exactly where it’s wanted.

5.         Provide what’s wanted where it’s wanted exactly when it’s wanted.

6.         Continually aggregate solutions to reduce the customer’s time and hassle.

Let’s examine these principles one at a time. . . To read the entire article, please go to the URL below.

(For more on these principles, see our book Lean Thinking)

 Making Lean Consumption Work

We believe that consumers will be quick to learn their role in lean consumption. Most of us would surely embrace the opportunity to solve our consumption problems completely, getting just what we want, when we want it, where we want it, at an attractive price from a small number of stable providers, with no waste of our time, and with no unpaid work.  The real challenge lies with the retailers, service providers, manufacturers, and suppliers that are not used to looking at total cost from the standpoint of the consumer and are even less accustomed to working with customers to optimize the process of consuming. Lean production has clearly triumphed over similar obstacles in recent years to become the dominant global model. Can lean consumption, its logical companion, be far behind?

Some people look at things that are and ask 'why?'

I look at things that aren't and ask 'why not?'

John F Kennedy

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6.         Medical Myths: We Can’t Provide Health Care to 300 Million Americans?

The prophets of gloom, Ehrlich and Nixon and other Malthusians, didn’t think we could provide food and health care to 300 million Americans. But as we saw in the forgoing articles, we are living longer and healthier lives, outstripping the countries with state health care. Our population will be 400 million by 2043, and by 2075, our population will be 600 million Americans. Can you fathom the wonder of it all? We will still be providing the world’s best health care to this enlarging population, exceeding the Countries of Europe with government health care despite their decreasing population.

Here we are with less than one-twentieth of the more than 6 billion people on our planet. And we have the greatest wealth brought about by the freedom and economic foresightedness of our parents and grandparents who came to this country to escape the oppressive governments of Europe and now the rest of the world. This five percent has produced more inventions, won more Nobel Prizes, allowed more people to lift themselves out of poverty than all the socialistic schemes of Europe and the entire world. The countries of Europe and Asia require their children, starting in grade school, to learn the language of that one-twentieth as their key to success. The Europeans present their Medical Congresses in English rather than their native language. Many European States are trying to implement the freedom in medical practice that we enjoy.

Why would anyone even think of trying to emulate the socialistic medical structures of European Medicine? They have failed their own people and will continue to fail. Why would we want to import failure? Single-payer health care is a dead issue.

There are many bright and innovative ideas surfacing in American Medicine. This Quarter HPUSA is presenting another integrative approach. See section 8 below.

By 2050, the world population is expected to increase to 9.1 billion from 6.5 billion today. Nine countries are expected to account for half the world's projected population increase: India, Pakistan, Nigeria, Dem. Rep. of Congo, Bangladesh, Uganda, U.S., Ethiopia and China. There are innovative ideas surfacing in several of them. See the story of Bangladesh in the MedicalTuesday for September 24, 2006. 

Medical Facts:  Free Enterprise will provide health care to 9.1 Billion on this globe. State Medicine can’t provide it to 400 million in the EU today. Most of them still like the security of waiting in line.

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7.         Perspectives on Capital Hill: The White House May Be Losing the Veteran’s Support

One group Capital Hill and White House could always depend on for support in a war effort was the 25 million veterans and the 45 million family members – all voters.

I see veterans every week. Some of them have been irreparably harmed by the war in Southeast Asia. The type of injury is quite variable. Many are having nightmares for a variety of reasons. This week, I saw a 60-year-old man, who, during his tour in Vietnam, was given a direct order to drive an 18 wheeler semi-trailer truck across that country. When he pointed out that he did not have the credentials and did not feel competent to drive such a truck, he was given illegal papers and a direct order “to drive” and he did. During that trip, he ran over a 17-year-old girl and killed her. It was brushed off by his superiors. But the memory still haunts him. He said that he still thinks about that tragedy every day of his life and it awakens him nearly every night. Can we imagine 40 years or 14,000 nights where his sleep was interrupted by events of a war that he states was not fought to win?

This is being reproduced by the war in the Mid East. The prevailing sentiment, which was also vocalized by my patient above, is that we are the most powerful nation on the face of the earth and our government doesn’t have the will to use that power to eliminate or at least conquer the enemy. Veterans feel that the government is allowing our military to be used as canon fodder on their one-year-or-so activation. Many of these veterans have such severe psychiatric problems from their experiences in the third world that they will never be able to function normally in society again.

Veterans, including their spouses, see no problem in using whatever weapons we have to destroy the enemy just as in any other world war. They feel the enemy is showing the world that we are a paper tiger rather than a power house to be reckoned with. By not using the force available to us, these 70 million voters may just elect the other political party into power that would make us even more like a paper tiger. War and politics is a dangerous combination. The health fall out is beyond comprehension for most of us. 

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8.         What's New in US Health Care: The Intersection of High Tech and Total Health

What does it take to create truly engaged health care consumers? Along with tools, information, and quality care, it also requires consumers to participate in managing their own medical care. 

Kaiser Permanente is making an unprecedented investment to help providers and consumers alike participate in managing health care. Kaiser Permanente HealthConnect™ will integrate members’ medical records across the country into one seamless network. Kaiser Permanente –HealthConnect is a major innovation – it’s the largest civilian health care information technology system ever implemented in the U.S.

Through, members will have access 24 hours a day, seven days a week to key portions of their Kaiser Permanente electronic medical record, in addition to existing features like appointment scheduling, prescription refills, and health education resources. KP members will have the freedom to manage their health care when it’s most convenient for them.

They’ll be able to:

View future doctor appointment information.

Access summaries of recent office visits 

Print immunization records

View summaries of ongoing health conditions

Exchange secure messages with their doctor’s office

View selected lab results

Segments of Kaiser Permanente HealthConnect are already up and running in California, and the system is scheduled to be fully functional in California in 2008.

Simply shifting responsibility to consumers for health care funding won’t control escalating health care costs. Consumers need tools to help them make better decisions and improve their health. Kaiser Permanente’s care delivery system is designed to keep members healthy by focusing on preventive medicine. We’ve always been committed to member education and engagement. HealthBuilder (HRA) by Kaiser Permanente is another big step down that path.

Resources available include the following:

Health encyclopedia

Research a health condition, learn more about treatment options, and get in-depth information from trusted sources to help you make decisions about your health.

Drug encyclopedia

Look up detailed information on thousands of drugs, including instructions, side effects, and precautions.

Featured health topics

Our featured health topics section offers tips for healthy living and trustworthy information on common conditions.

Kaiser Permanente hospital and medical office locations

Find a Kaiser Permanente medical office, pharmacy, or hospital using our online search tool.

Allows members to refill prescriptions, make nonurgent appointments, and contact medical professionals online, and enroll in health classes and programs at many Kaiser Permanente facilities.

[The above was sent by a member of Medical Tuesday who is the owner of a large insurance agency. He just received this information after Kaiser Permanente completed the introduction of their HRAs in Southern California and are now introducing them to employers in Northern California. It appears that KP has many of the elements of Lean Production and Lean Consumption of the Lean Enterprise Institute that their president, Jim Womack, presented, featured above and in a previous issue. Kaiser Permanente has all the necessary elements in place to be the most efficient integrative health care system in the United States, if not the world. Hopefully, the National Health Service in the UK will act on a proposal to have Kaiser Permanente manage their NHS.]

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9.         Health Plan USA: Free Market in Health Care -A Work in Progress

About this time every year, we get a number of requests from Blue Cross, Blue Shield, Hospitals, IPAs, Workers Comp, and just about everyone we do business with to complete recredentialing applications. Some want separate credentials for their HMO, PPO and premium divisions. Even at two hours to complete each one, the 12 packets is still two days of unpaid work a year.

HPUSA, our working group for a truly free and open health-care system, has several basic tenets. One is that the plan will accept licensure as the measure of acceptance. Any licensed physician, hospital, urgent-care center or other service provider can electronically bill the system with just their licensure which can easily be crosschecked.

The ICD9 codes have become overbearing. On every laboratory or x-ray request, we are required to list the ICD9 diagnostic codes. For some laboratory requests, one has to look up several. Every diagnosis in our medical records requires and ICD9 code. Adding up several minutes on every patient comes to an hour or so a week or about 50 hours a year, or an additional week of work without pay.

HPUSA feels that it is not important to an insurance carrier to know why a patient is being seen by a family doctor, an internist, a pediatrician or an obstetrician. That a patient goes to see a physician for any medical reason is sufficient cause to pay reimbursement for the office call. Thus, HPUSA will save one week’s wages per year.

The CPT codes are becoming a criminal net for the federal bureaucrats to arrest doctors for using the wrong code. To check off the individual items discussed or examined if laboriously recorded to come up with one of five levels of complexity, is labor intensive and adds nothing to a patient’s care. Again, HPUSA feels there is no need for the large number of CPT codes that are revised each year making it more complicated than necessary.

HPUSA feels that an internist’s office call is about the same as other internist's office calls and there is no need to have five levels of CPT care. It will all average out. A nurse practitioner in an internist’s office will provide the same level of care as a NP in another internist’s office. Hence, that level of care will also average out with out separating into multi-levels. A visit to see the medical assistant for an injection or a BP reading will also average out with other MAs in internist’s offices and will be reimbursed on that level. Every office only needs these three levels of care defined by the Doctor, the Nurse or the Medical Assistant rather than the current cascade that CPT enforces. Hence, there are no CPT codes in the current working model for HPUSA.

This will also save a similar 50 hours a year in researching codes and trying to figure out exactly what the Feds want. It could save doctors tens of thousands of dollars if the government disagrees with your determination.

To keep this plan truly market based, our working co-payment level for office calls is 30 percent. This will make every patient police his own needs and he will not obtain unnecessary care. This eliminates a whole army of review nurses saving $millions.

At this time, we are looking for an insurance carrier willing to do a fully market-based plan where the system will bring about the leanest possible health-care consumption. We think doctors and other providers will immediately see the benefit of this. We welcome your input.

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10.        Restoring Accountability in Medical Practice, Insurance and Government Programs 

  • 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. . . Since elections are close at hand, be sure to check to see if your candidate signed the tax pledge on the opening page.
  • 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 review the candidate survey, please 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 Op-Ed articles, some of which you and I may disagree on, go to To visit the Objectivist Academic Center, go to
  • 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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Del Meyer

Del Meyer, MD, CEO & Founder

HealthPlanUSA, LLC

6620 Coyle Ave, Ste 122, Carmichael, CA 95608

Words of Wisdom

Your thoughts become your words. Your words become your actions. Your actions become your habits. Your habits become your character. Your character becomes your destiny. –General Dave R. Palmer

People who complain about taxes can be divided into two classes - men and women. -Anonymous

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This Month in History

On October 1, 1908, Henry Ford introduced the Model T, known affectionately as the Tin Lizzie. With it came assembly lines, mass production and interchangeable parts we take for granted today. This may have been the first Lean Production, that had to be re-implemented at Toyota which got their ideas from reading Henry Ford.

On October 1, 1939, Winston Churchill said, “I cannot forecast to you the action of Russia. It is a riddle wrapped in a mystery inside an enigma.”