HEALTHPLANUSA . NET
Community For Affordable Health Care
Vol VII, No 3, October, 2008
Utilizing the $1.8 Trillion Information Technology Industry
To Transform the $2.4 Trillion HealthCare Industry into Affordable HealthCare
In This Issue:
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1. Feature Article: Pulling It Together . . . Drew Altman, PhD, Pres & CEO, Kaiser Family Foundation, www.kff.org
Moving Away From Employer Based Coverage: Don't Forget Public Opinion
One of the underlying big issues in the unfolding health reform debate is whether most Americans should continue to get insurance through work where they get it today, or purchase it themselves in the individual private health insurance marketplace. Senator McCain promotes moving to individual insurance and having individuals rather than employers make coverage decisions, as has President Bush. But this is not only a conservative idea. Many on the liberal side -- such as Senator Ron Wyden and SEIU President Andy Stern -- also would like to see the country move away from the employment-based health insurance system. They see the current tax preference for employment-based health insurance as regressive because subsidies are related to marginal income tax rates and therefore go disproportionately to higher income workers (in fact, a majority of the benefits from the tax exclusion are estimated to go to families with incomes greater than 400% of the poverty level). All are tempted by the $200 plus billion in federal revenues eliminating the tax preference would produce, which could, among other things, be used to pay for covering the uninsured.
Democrats and liberals would take steps to create a more structured market for individual insurance -- allowing people to buy into a purchasing pool like the Federal Employees Health Benefits Program or a public plan like Medicare, as well as requiring insurers to accept all comers regardless of pre-existing health conditions. Senator Obama's health reform plan contains many of these features, but leaves the tax preference for employer-sponsored coverage intact. Conservatives take the opposite approach, relaxing insurance regulations and promoting more unfettered competition, while promoting measures such as high risk pools as a fallback for people with health conditions that would exclude them from non-group insurance.
As discussion of moving away from the employment-based system continues, not very much attention has been paid to a giant question: How will the public (and voters) feel about such a big change? Health reformers have learned the hard way in the past that whatever the appeal of policy proposals on their merits, they ultimately have to be acceptable to the public or they will not fly.
With this in mind, we asked people with employment-based insurance a series of questions on our most recent tracking poll about whether they thought purchasing insurance on their own would make things better or worse for them. You can see the results below. (Go to website to review) In every case, between 63 and 81 percent said it would make things worse. There were no meaningful differences by party affiliation.
The point is not that moving away from employment-based health insurance is a good idea or a bad one –- polls tell us where the public is at a point in time, not always what is the right thing to do -- but that in health reform the burden is always on those who are proposing that people change their current arrangements to persuade the public of why change makes sense and to offer them positive inducements to try something new. . . To read the entire report, go to www.kff.org/pullingittogether/062608_altman.cfm.
-- Published June 26, 2008
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Information technology has the potential to restructure medical care in ways that can solve many of these access problems, while reducing costs and improving the quality of care. Already, entrepreneurial providers are creating services outside the third-party payment system that allows patients to pay directly for access to physicians or nurses electronically or by telephone, says Devon Herrick, a senior fellow with the National Center for Policy Analysis.
Consider the example of TelaDoc Medical Services, a phone-based medical consultation service that links physicians, patients and health plans across the country. The service is not intended to replace primary care providers, but it allows patients who are away from home to obtain less expensive and time-consuming treatment by contacting a local physician, rather than visiting an emergency room or expensive urgent care center.
· An individual enrollee pays $35 for each consultation (compared to an emergency room visit costing an average of $383), and the service is available around the clock.
· For efficiency, medical records are digitized and placed online, allowing medical personnel access from anywhere in the country.
· TelaDoc guarantees a physician will return the call within three hours or the consultation is free, but customer surveys show that most calls are returned within 30 to 40 minutes.
· A physician returns a patient's phone call within 30 minutes (or less) 50 percent of the time.
· Seventy-five percent of patient calls are returned within one hour.
· Eighty-eight percent of those who used the service reported they saved time and money compared to a traditional office visit or a trip to the emergency room.
A recent analysis by the consulting firm Mercer found that 97 percent of users rated the service good or outstanding, and 98 percent said they would use it again.
Source: Devon Herrick, "Physician Care and Telemedicine," National Center for Policy Analysis, Brief Analysis No. 624, August 21, 2008. www.ncpa.org/sub/dpd/index.php?Article_ID=16935
For text: www.ncpa.org/pub/ba/ba624/
For more on Health Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=16
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3. International Medicine: Tales from the Health-care Crypt
Lessons from Sweden’s Universal Health System: Tales
from the Health-care Crypt
by Sven R. Larson, Ph.D.
You cannot buy a new Lexus for $20,000. Small budgets cannot buy first-class medical care either. Yet one of the most persistent arguments for single-payer health insurance is that it will somehow give everyone gold-plated care at little or no cost.
There are a lot of dry statistics to prove just how wrong this notion is. But there is a side of this issue that rarely is told, especially not by advocates of a government medical monopoly. It is the story of those who pay the price for the serious rationing in a single-payer system.
Universal Rationing: Real-Life Examples
Rationing of care is a reality under universal health insurance. Yet, its advocates seem universally oblivious to it. In an effort to unmask the reality of “universal coverage,” here are some actual case histories of real people with real experiences. They were reported by Swedish news media, in some instances numerous times. Sweden has longer experience with socialized medicine than almost any other country in the world.
In October 2003 Mrs. A., who lives in Malmo, Sweden, gave birth to a baby boy. She was signed out from the hospital after delivering the baby. There are not enough beds, so delivering a baby “without complications” is an outpatient procedure. Budget cuts have eliminated beds and medical staff.
The next day Mr. and Mrs. A. noticed that their baby was weak and did not want to eat. As is common in Sweden, they did not call a doctor. Instead they called the tax-paid “TeleMedicine” service. Nobody advised them to go see a doctor right away.
The following day their baby died of pneumonia.
In May 2006 another couple lost their three-year-old son to the budget-starved medical system. When Mr. and Mrs. B.’s son suffered from diarrhea and had been vomiting for almost two days, they took him to the emergency room at the nearby university hospital. A doctor ordered a supply of intravenous fluids, and the boy was sent on to the pediatric clinic to have them administered. When he arrived, the nurses had no time for him. Mr. and Mrs. B. repeatedly called on the medical staff to ask why nobody was coming to give their son the intravenous fluids he so desperately needed.
Every time they got the same answer: nobody has time. They have too many patients and too little staff.
Six hours later the three-year-old boy died of heart failure.
You do not have to be a child to die from denial of care in Sweden. In April 2005 Mr. C., 61 years old, became concerned about an unusual feeling of fatigue. He went to see a doctor at the local government-run clinic. The doctor sent him home with some encouraging words.
Mr. C. came back a while later with worsened symptoms. Again he was sent home after a superficial examination and with more reassurance.
Over the next year and a half Mr. C. visited this tax-paid local clinic a total of 14 times. He had no choice—all Swedes have to go through a government-run primary care physician at a tax-paidclinic in order to see a specialist. He developed blood in his urine. But the doctors refused even to take a blood test.
They told Mr. C. and his son that they were denying him the blood test because of budget restrictions imposed by government bureaucrats.
When, finally, Mr. C.’s son convinced the doctors to do one blood test, they found out that Mr. C. had cancer. He was referred to a regional hospital. There they established that his cancer, originally curable, had spread throughout his body. There was nothing left to do. He died shortly after.
Even those who do not die from encountering denials of care suffer considerably under Sweden’s universal coverage. Mr. D., a multiple sclerosis patient, lives in Gothenburg, a city of 500,000. His doctor told him about a new medicine that is considered a breakthrough in MS treatment. But, when the doctor put in a request to have Mr. D. treated with it, the request was denied. Reason: it would cost 33 percent more than the old medicine, and that was more than the government was willing to pay.
For most Swedes there are no longer any subsidies for prescription drugs. People with exceptionally high pharmaceutical costs get some subsidies, but they have to pay the greater share themselves.
When the government denied Mr. D. the new medicine on the grounds that the subsidies would cost too much, he offered to pay the full cost of the medicine himself. He was denied the option to pay full cost out of his own pocket because, the bureaucrats said, it would set a bad precedent and lead to unequal access to medicine. In Sweden, there is no way to obtain access to medication outside the government-run system.
There are other absurd examples. How many times have you gone to see your doctor only to find security guards posted in the waiting room?
This is reality in Malmo, Sweden’s third largest city. To see a physician the 280,000 residents of Malmo have to go to one of two local clinics before they can see a specialist. Except during business hours, only one of the two clinics is open to serve all the city’s residents.
As a result the clinic is severely overcrowded. The security guards serve two functions. They keep patients from becoming unruly as they sit and wait for hours to see a doctor, and they keep new patients from entering the center when the waiting room is considered full.
Opening the second clinic during off-business hours is considered too costly.
Government control over medicine also leads to government arrogance. In Gothenburg, a hospital was blessed with having a talented orthopedist on its staff. Dr. Leif Sward worked part time for the government-run hospital, part time for a local soccer club at its private orthopedic clinic, and part time for the British national soccer team.
You would expect a man with such credentials and experience to be considered a prized asset in a tax-supported hospital. But the government bureaucrats were unhappy with the fact that Dr. Sward was not working full time for them. They considered his work for the private health clinic “competing employment”—the soccer players should come to the tax-supported hospitals instead so as to increase their revenues. So they gave Dr. Sward an ultimatum: quit the private sector or leave us.
Dr. Sward chose the latter.
By giving Dr. Sward this ultimatum, the medical bureaucrats showed that their priority was to control and stifle competition and choice, an action contrary to the interests of patients.
In the midst of all this, you would expect Sweden, oft cited as the epitome of equality, to at least care for women’s health better than any other nation. Not so. Sweden is suffering badly from lack of physicians with expertise in interpreting mammograms. The city of Uppsala, with 200,000 people, well known for one of Europe’s oldest universities, has only one specialist in mammography. This is not unique. Sweden’s National Cancer Foundation reports that the situation is so precarious that within a few years most women in Sweden will not have access to mammography. This is, in part, because all medical schools are under government control and subject to the same budget-cap policies as the rest of the system.
What these horror stories from the health-care crypt can tell us is that universal health insurance is bad for patients in a very profound, direct sense.
But there is also an indirect effect, and over time an even more dangerous side to having the government starve a nation’s medical system. Dr. Olle Stendahl, professor of medicine at Linkoping University, pointed this out in the national Swedish daily newspaper. Referring to the 2005 Nobel Prize in Medicine, awarded to Dr. Barry Marshall and Dr. RobinWarren for their discovery of Helicobacter pylori, Dr. Stendahl explained that part of the reason for their innovative research was a medical system that encouraged research and innovation. But, he continued, discoveries of this magnitude are ruled out in Sweden:
In our budget-governed health care there is no room for curious, young physicians and other [medical] professionals to challenge established views. New knowledge is not attractive but typically considered a problem [that brings] increased costs and disturbances in today’s slimmed-down health care…. Primarily the system endorses health care regions and administrative directors who can show a surplus in their budget. Quality of care and patients’ well-being are second-tier goals. . .
The Cost of a Transplant to America
While it may seem as though the Swedish tax rates are off the chart compared to American taxes, it would not take us long to get there if the United States made the mistake of adopting socialized medicine for all.
It has been estimated that a Swedish-style single-payer health insurance system in America would cost the median-income household some $17,200 per year in health care taxes. . .
If we implement a universal, single-payer model in America today, the negative effects will reliably occur about a generation from now. The question that we need to ask ourselves as we enter the election season is this: Are we willing to send that bill down the road for our children to pay?
Socialized Medicine, the Medicine of the World Outside of the USA, India & S. Africa,
Does Not Give Timely Access to Healthcare, It Only Gives Access to A Waiting List.
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4. Medicare: Myths And Facts
Myth #1: Beneficiaries are just getting back what they have paid in.
Nothing could be further from the truth. "Current recipients receive over $100,000 more in benefits than they pay in" (Medicare Follies With Orchestration, The Washington Times, June 27, 1997, by Doug Bandow, senior fellow at the Cato Institute).
Medicare beneficiaries are under the impression that the money they paid in payroll taxes over the years was put into an actual fund somewhere, where it earned interest and grew over the years, and that fund is now being used to pay for their medical care. That type of fund, however, does not exist. Medicare is financed in a "pay as you go" fashion, whereby wealth is transferred from current workers to retirees to pay for their medical care.
Medicare Part A is funded primarily from payroll taxes, so Medicare beneficiaries who are not currently working and paying payroll taxes aren't contributing anything to Part A (hospitalization) expenses. Part A is strictly a wealth transfer program. Medicare Part B (physician services + home health care) is funded by a combination of beneficiary premium dollars and general tax revenue dollars: 25% from premiums and 75% from general tax revenues. Overall, 87% of total Medicare revenues for Part A + Part B comes from current taxpayers, and only 13% comes from Medicare beneficiaries' premiums and tax payments.
Myth #2: Medicare pays the reasonable cost of medical services.
Government price controls have, in some cases, slashed Medicare fees to 10 cents on the dollar compared with the Medicare "allowed charge" 10 years ago. This has forced those who provide these services not only to work without payment, but actually to subsidize the cost. The harder they work, the more money they lose.
Myth #3: Without Medicare, most seniors wouldn't have medical care.
The government used carefully doctored statistics to mislead the public into believing that nearly half of the senior population did not have medical insurance coverage prior to the passage of Medicare.
These statistics, taken from a 1964 Department of Health, Education and Welfare report, didn't count an enormous number of people who were covered by a variety of programs including: indemnity policies that paid cash benefits, existing government programs such as the Veterans Administration, and welfare. It also didn't count those who could afford to pay their own way-i.e. lack of "insurance coverage" is not the same as lack of access to medical care.
The fact was that 77% of seniors were eligible for the Kerr-Mills program (Medical Assistance for the Aged), which had been passed into law a full five years before Medicare. The remaining 23%-if they couldn't afford to pay for their own care-could receive free care at their local hospital. Under the Hill-Burton Act, hospitals agreed to provide free care to anyone who needed it in return for government grants and loans.
Thus, all seniors-and everybody else-had access to medical care whether they could afford it or not. Physicians also were able to provide a substantial amount of charity care to patients who needed it, unlike today, when the physician risks accusations of fraud with accompanying prison time and ruinous fines for failing to charge a Medicare patient what the government deems the patient should pay. Charging a Medicare patient $0.0 can get a physician into a world of trouble today because of government regulations.
Myth #4: Seniors were in poorer health before Medicare.
Not so, at least not according to the seniors themselves. In a 1960 survey conducted by Emory University (i.e. 5 years before Medicare was passed into law), 10% of seniors reported that they were in poor health. Today, after 36 years of compulsory, one-size-fits-all medical care under Medicare, 26.7% of seniors report that they are in poor health.
Myth #5: Medicare is low-cost insurance.
The Medicare program covers approximately 40 million people at a cost of about $220 billion dollars-or about $5,200 per person. By contrast, the medical insurance program for Congress and other federal employees, the Federal Employee Health Benefits Program (FEHBP), covers approximately 9 million people at a cost of about $2,200 per person. The FEHBP offers people more freedom of choice at less than half the cost of the Medicare program. . . .
Dateline 1962: "The Great Madison Square Garden Debate" - The AMA vs. Medicare.
AMA President Dr. Edward Annis had the following to say: "This Bill (King Anderson Bill) would put the government smack into your hospitals! Defining services, setting standards, establishing committees, calling for reports, deciding who gets in and who gets out-what they get and what they don't-even getting into the teaching of medicine-and all the time imposing a federally administered financial budget on our houses of mercy and healing. It will create an unpredictable burden on every working taxpayer. It will undercut and destroy the wholesome growth of private voluntary insurance and prepayment health plans for the aged which offer flexible benefits in the full range of individual needs. [Just prior to the passage of Medicare, 7.7 million seniors had private insurance coverage-now there is no private insurance market for seniors at all.] It will lower the quality and availability of hospital services throughout our country. It will stand between patients and their doctors. And it will serve as the forerunner of a different system of medicine for all Americans."
The Association of American Physicians and Surgeons (AAPS) also weighed in on the great Medicare debate. Founded in 1943, the AAPS is the only national medical organization that has consistently supported free-market principles in medicine and has consistently opposed all attempts to degrade the patient/physician relationship via government-controlled, socialized medicine. The AAPS has never minced words-it has repeatedly pointed out to the American public that Medicare is socialized medicine for the elderly and that socialism is a concept abhorrent to a nation based on individual freedom.
In 1965, AAPS President Dr. E.E. Anthony had this to say about the proposed Medicare program: "Since the government will provide and control hospitalization services and the financing thereof, since the government will control the medical services offered to the aged by financing the subsidization of the insurance carriers responsible, therefore, the program is one of outright, unadulterated SOCIALISM!" (testimony provided to the Senate Finance Committee, 1965). He went on to say that "the physician's judgment would be open to question by others not responsible for the patient's wellbeing. His diagnostic and therapeutic decisions would be subject to disapproval by those controlling the expenditure of tax money."
AAPS advocated "non-participation" in socialized medicine to its members at that time and maintains a non-participation program today.
In an attempt to quell doctors' fears of government interference in Medicine and government destruction of the private insurance market and freedom of choice for seniors, the Medicare law contained the following three sections:
"Sec. 1801: Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee or any institution, agency or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency or person."
[Now with 132,000 pages of Medicare regulations, the federal government interferes with every aspect of the practice of medicine. Federal bureaucrats oversee all hospital care, "setting standards" (as through JCAHO) and demanding reports. Via "medical necessity" pronouncements, they determine who gets in and who gets out of the hospital. And, via DRGs, they determine how long a Medicare patient will stay. They determine the manner in which Medical services are provided and how they must be documented. And, the government has instituted a system of price controls and price fixing for most Medical services provided today (RBRVS, Balance Billing Laws, Correct Coding Initiatives etc).]
"Sec. 1802: Any individual entitled to insurance benefits under this title may obtain health services from any institution, agency, or person qualified to participate under this title if such institution, agency, or person undertakes to provide him such services."
[The federal government now routinely steers "beneficiaries" to participating physicians in all of its informational brochures and on all Explanations of Benefits sent to patients. Medicare bureaucrats have also acted to defame non-participating physicians by pronouncements of guilty until proven innocent, thus destroying patient-doctor relationships. In a country where freedom of speech and freedom of choice are cherished, the government has undertaken malicious initiatives at every turn to punish those ethical physicians who exercise their freedom to choose not to participate in the government's program of socialized medicine for the elderly.]
"Sec. 1803: Nothing contained in this title shall be construed to preclude any State from providing, or any individual from purchasing or otherwise securing, protection against the cost of any health services."
[The private health insurance market, however, has been totally destroyed by the government with the passage of the compulsory Medicare program. So, although the individual is not "precluded" from purchasing private health insurance, the government has made sure that no private health insurance is available for purchase and that "beneficiaries" have only one "choice"- one-size-fits-all government medicine.]
The Medicare system was doomed from its beginnings. Drastic change is needed to save medicine for today's seniors, and their offspring.
The first step is to find out the truth and not be misled by the Medicare Myths. To read the rest of the Myths and the remainder of the article, go to www.aapsonline.org/brochures/myths.htm.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Here's a guarantee that will get your attention. Geisinger Health System, which runs three hospitals in central Pennsylvania, not only charges a flat fee on coronary-artery bypass surgery and all of the pre- and post-operative care that goes with it, but it also offers a warranty: If a preventable complication puts you back in the hospital within 90 days, Geisinger will eat the cost.
Geisinger's doctors and executives -- who sound like management consultants with their talk of "unnecessary variation," "best practices," and "managing change in complex systems" -- are trying to do more than reengineer heart surgery. They're turning this 92-year-old hospital network/insurance company in Danville, Pennsylvania, into an ambitious laboratory for organizational and financial experiments aimed at fixing American health care. And some of the ideas may actually work.
When CEO Glenn Steele, a surgeon and oncologist, was recruited from the University of Chicago medical school five years ago, Geisinger was recovering from a brief, unhappy merger with Penn State Hershey Medical Center that left it shaken but also open to change. This was ideal for Steele. Because Geisinger had its own hospitals and health-insurance plan, employed 600 doctors directly, and served a stable and therefore easily studied demographic, it was just the kind of place you'd pick if you wanted to test big hypotheses for reforming the health system.
On Steele's watch, Geisinger has expanded computerized patient records and established a venture unit to develop treatments for possible licensing. But the guarantee program, called ProvenCare, represents arguably the biggest challenge to the status quo.
To Steele, the underlying idea is simple enough: "We shouldn't get paid if we don't do the right thing." Most American health care is provided on a fee-for-service basis. If you have six operations and die, that's better financially for your hospital than if you have one procedure and go home. How to replace fee-for-service with pay-for-performance (P4P) has been the talk in medical policy circles for some time. P4P is often linked to "evidence-based medicine," which simply means doing what clinical data say works, rather than relying on habit, hopes, or tradition.
ProvenCare is based on CEO Glenn Steele's concept that "we shouldn't get paid if we don't do the right thing."
ProvenCare sets a fixed price -- which includes a percentage of the historical costs of complications -- for a given medical problem. That creates a powerful financial incentive to get things right the first time. Says Dr. Ronald Paulus, Geisinger's chief innovation and technology officer: "We had to put our money where our mouth was." Steele decided to start with coronary-artery bypass graft (CABG, pronounced cabbage) surgery because it's a high-volume, high-margin procedure that's well studied and has low mortality and complication rates.
"We did this to test whether we could take a very complex system across three hospitals with a huge number of people involved and reliably do something we promised we'd do," says Dr. Alfred Casale, formerly Geisinger's chief of cardiothoracic surgery and now chief medical officer of one of Geisinger's hospitals. Before, he explains, "if the physician's assistants got called to the bedside of somebody who had developed rapid atrial fibrillation [the irregular heart rhythm that happens about 20% of the time after a heart operation], the first thing they would ask wasn't, 'How is he?' It was, 'Whose is he?' Because what they would do next depended on the idiosyncrasies of the surgeon and the cardiologist."
ProvenCare eliminates that kind of variation. After studying guidelines adopted by the American Heart Association and the American College of Cardiology, as well as mountains of clinical research, Steele's seven cardiothoracic surgeons developed a list of 40 steps that should be taken -- or at least considered -- in the treatment of every CABG patient, from the first clinic visit to discharge. "None of the 40 things are new," Casale explains. "Being certain that they are all being done all the time is the real innovation." It's not a question of inventing a secret sauce, he says, so much as guaranteeing "every hamburger that comes out of the place has the secret sauce in it."
For patients, of course, getting what's been proven to work is nothing more than we expect from a Jiffy Lube. But according to a 2003 New England Journal of Medicine paper, only 55% of American patients get all the treatment that is generally accepted as necessary for their problems. To make sure the number at Geisinger is near 100%, surgeons, pre- and post-operation, face a computer screen that asks a set of questions: Is the patient on a beta blocker? A statin? Were antibiotics given at least 60 minutes before surgery and discontinued after 48 hours? A staffer sends an email query if there's no response to any of the 40 steps.
There's a financial component to ProvenCare -- doctors receive bonuses based in part on following the protocol -- but Geisinger insists it's not trying to force its staff to practice what is pejoratively known in the industry as "cookbook medicine." A doctor who concludes there are good reasons not to do one of the 40 steps simply documents that decision in the patient's record. "What we're trying to do," Casale says, "is avoid the moment of smacking yourself on the head at the end of a procedure and saying, 'Jeez, I should have used antibiotics!' "
The results have been promising. A paper published in the fall of 2007 in the journal Annals of Surgery studied 181 CABG patients subject to the ProvenCare protocol between February 2006 and February 2007. Compared to nonchecklist patients, the ProvenCare group had 16% shorter hospital stays. Their bills were about 5% lower. While Casale admits that the study was small, he insists the results are still significant: "We've seen a 45% decrease in readmission rates, 60% decrease in neurologic complications -- meaningful changes that you'd certainly be happy to get even if they don't meet a statistician's level for ringing a bell." He says surgeons opted to skip a step in only three cases. . .
In the meantime, Geisinger continues to compile success stories, including that of CEO Steele, who became patient No. 86 in the ProvenCare CABG program. "I was in and out of the hospital in two-and-a-half days," he says. Casale, who was Steele's surgeon, says the case opened his eyes to how complex a routine operation really is: "Two weeks after, the head of our IT group called me and said, 'Al, I just looked through [Steele's] chart, and I want to send you a list of everybody that accessed the medical record from the time he was seen in the clinic to two weeks post-op.' There were 113 people listed -- and every one had an appropriate reason to be in that chart. It shocked all of us. We all knew this was a team sport, but to recognize it was that big a team, every one of whom is empowered to screw it up -- that makes me toss and turn in my sleep." . . . To read the entire article, go to www.fastcompany.com/magazine/129/the-cure.html. (www.fastcompany.com/node/1007043/print)
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6. Medical Myths: UN's Tendency to Misrepresent Science
Climate change, health and myth-information were the themes of Professor Paul Reitner's conference for the 3rd Geneva Round Table organized by IPN and the Institut Constant de Rebecque July 3rd 2008
According to Prof. Reiter medical entomologist at the Institut Pasteur in Paris, bodies such as the WHO and the Intergovernmental Panel on Climate Change (IPCC), are promulgating a misleading and alarmist interpretation of the relationship between vector-borne diseases and temperature.
The reality is that the epidemiology of these diseases is a highly complex interplay of the ecology and behaviour of both humans and vectors that defies simplistic analysis. The resurgence of many of these diseases is a major cause for concern, but it is facile to attribute it to temperature: the principal determinants are politics, economics and human activities.
If the WHO, IPCC and other authoritative bodies continue to misuse science, policies will be enacted that will be both ineffective and counterproductive.
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7. Overheard on Capital Hill: Obama and Health-Care Equity, WSJ, Oct 8, 2008
Barack defends tax subsidies for the rich.
For someone running as the tribune of "change," Barack Obama showed again in last night's debate that he sure is comfortable with the status quo on health care. He continued his recent assaults on John McCain's health reform even though it is precisely the kind of plan that someone of Mr. Obama's professed convictions ought to support.
The attacks include swing-state TV spots and Joe Biden's multiple distortions, though the most over-the-top come from the candidate himself. Over the weekend, Mr. Obama called the McCain plan "radical," "out of line with our basic values" and, in case he wasn't clear, "catastrophic for your health care." Since Mr. McCain offered only a once-over-lightly defense of his plan, allow us to give it a try.
Perhaps Mr. Obama is so agitated because Mr. McCain's proposal is highly progressive. The Republican wants to readjust the subsidies that Congress channels into health coverage for business so that lower- and middle-wage workers aren't shortchanged, as they are now. Currently, people who get insurance through their employers pay no income or payroll taxes on the value of the benefit. This is revenue the government forgoes to encourage certain behavior. If those losses were direct spending, the tax exemption would have cost more than $246 billion in 2007.
But all that money props up only employer-provided insurance. For reasons of historical accident and lobbying clout, individuals who buy policies get no tax benefits and pay with after-tax dollars. Mr. McCain is proposing to make the tax benefits available to everyone, regardless of how they purchase their insurance. . .
Mr. Obama doesn't want to let people make this choice. He even claims it would amount to "taxing your health-care benefits for the first time in history," which is a wild distortion. His point seems to be that because companies wouldn't have to pay for health care, they could raise wages and thus taxes would also increase for workers on those higher incomes. But doesn't Mr. Obama want higher wages?
All in all, workers would come out ahead with the McCain plan. According to the left-leaning Tax Policy Center, the average taxpayer would see his tax bill drop by $1,241 in 2009. On average, lower-wage workers have more limited coverage as part of their compensation, mostly from small- or medium-size businesses. But the more generous the employer health plan, the more the tax subsidies increase. According to the Joint Committee on Taxation, the current employer benefit is only worth between $600 and $3,000 for people making under $100,000. The upper-income brackets save between $4,000 and $5,000.
The most affluent -- i.e., the top quintile of earners -- would be slightly worse off after 2013 under the McCain plan, though they'd still have plenty of options. Even as he routinely promises to raise taxes on "the rich," Mr. Obama is leaping to their unlikely defense here only to frighten everyone else. The McCain plan is fairer than the status quo, which subsidizes the most expensive employer (and union) insurance plans.
But don't take our word for it. Mr. Obama's chief economic adviser agrees with the McCain critique of the current system, or at least he once did. "This massive program of tax breaks is ineffective and regressive, wasting money on those who have health insurance while doing little for those who can barely afford it and nothing at all for those without it," wrote Jason Furman in 2006 in the journal Democracy. Before he joined the Obama campaign, Mr. Furman championed a health reform that relied on many of the same tax tools as Mr. McCain's.
In contrast to Mr. McCain, the Obama plan is all about expanding government health care. Mr. Obama is proposing a "public option" that is similar to Medicare but open to everyone of any age. With this new taxpayer-funded entitlement, private insurers would be crowded out as the government gradually paid all of the country's health-care costs.
Yet according to the Congressional Budget Office, federal spending on Medicare and Medicaid already takes up 4% of GDP today and will rise to an unsustainable 9% over the next two decades. Mr. Obama wants to add even more costs to this taxpayer balance sheet. The inevitable result as spending explodes would be price controls and rationing.
On choice, portability, quality and especially equity, the McCain health plan is far superior to Mr. Obama's. The Democrat is merely offering Canada on the installment plan.
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8. What's New in US Health Care: McCain Is the Real Health-Care Reformer
With less than a month to go, presidential candidate Barack Obama wants to deliver a knock-out punch by hitting John McCain on health care.
On Saturday Mr. Obama called his rival's health-care proposal "radical" and, in swing states, he is now blasting it in TV ads. Mr. Obama is also distributing mailers and organizing "Docs for Barack" meetings to rally voters.
It's good politics for Mr. Obama. But it's bad policy. Mr. McCain's proposal -- to give every American the tax credit businesses get for buying health insurance -- is the right prescription for what ails our health-care system.
The foundation of that system -- employer provided health insurance -- is crumbling. For decades, the percentage of Americans who get their health insurance at work has been shrinking. In August, the Census Bureau reported that the decline continues. Today, 59% of Americans get their health insurance through the workplace. Twenty years ago, three-quarters of us did. With costs skyrocketing -- health-insurance premiums roughly doubled since 2000 -- the current path we are on is not sustainable.
Mr. McCain recognizes that a large part of the problem is that the tax code favors employer-funded health insurance. The system, which began as a response to FDR's wage and price controls, is built on tax breaks that allow employers to buy health insurance with pretax dollars.
Mr. McCain doesn't want to scrap employer-based insurance. He would keep part of the tax deduction in place. But he wants to fundamentally change the way the system works and instead give the self-employed and individuals a tax break for buying their own insurance. There are several advantages to this approach:
- Choice. About half of those with employer-financed health insurance have a choice of exactly one plan -- and that plan is often designed to suit the needs of the employer, not the employee. In contrast, under the McCain proposal, families could opt out and join another plan -- perhaps offered by their church, union or trade association -- if it better suited their needs.
- Portability. Presently, changing jobs means changing health plans and, often, family doctors. It also means that if a worker loses his job, he can also lose his health insurance. Under Mr. McCain's plan, job status wouldn't necessarily affect health coverage.
- Labor mobility. By freeing workers of the need to stay in a job to keep their health insurance, Mr. McCain's plan would help create a more flexible workforce. A study by University of Wisconsin economist Scott Adams found that 20% to 30% of nonelderly men worry enough about losing their health benefits that they stay in jobs they would otherwise leave. . .
By being light on details, Mr. McCain has made himself an easy target. In a blog, Mr. Cutler attacked the senator by saying, "The heart of the McCain health plan is to take people who have secure, employer-based coverage (160 million of them) and throw them into the market where they buy on their own . . . ." Weary of these attacks, Mr. McCain's campaign has begun to waver and has said that his administration would first work on less controversial reforms.
That's too bad. On health reform, Mr. McCain is fundamentally right. As one prominent economist has noted, "Health insurance is not something that is made better by tying it to employment." That economist was Obama adviser David Cutler.
Dr. Gratzer, a physician, is a senior fellow at the Manhattan Institute. His most recent book, "The Cure: How Capitalism Can Save American Health Care" is now out in paperback.
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Dr. Altman in Section One above gives us a very good reality check. We can come up with the best solution to America’s health care and the public may not support it. The public doesn’t like change. They would rather grovel in the mess we have rather than face innovation, which they see as threatening to the status quo—their misinterpretation of security.
Devon Herrick in Section Two discusses Telemedicine. This is an innovation that will seek its place in the health care arena in the future along with email and a fluid interface of patients with their doctors and staff. One of the challenges of free standing Telemedicine is that the cost can be considerably higher than if Telemedicine were part of the patient’s health care plan so their own doctors could get paid for their advice. A doctor outside of one’s own practice in Telemedicine may order tests and prescribe without the full medical history and thus there would be loss of quality as well as cost effectiveness.
In Section Three, Dr. Sven Larson discusses the horror stories of what is frequently considered the world's premiere socialized medicine system. He tells us of children and adults dying for lack of care due to bureaucratic interference with health care and budget restraints in Sweden.
Dr. Lawrence Huntoon discusses, in Section Four, the 13 myths of our own socialized medicine program, otherwise known as Medicare. The great tragedy is that our own American people who still expound on the benefits of the Socialized Medicine for seniors don’t appreciate or even believe the broken promises of Medicare and that government can improve the program.
Peter Carbonara discusses, in Section Five, the bonuses for doctors who follow specified protocols. But doctors don’t want bonuses for a job; they just want to get paid for their services. Well done and Quality are every doctor’s middle name. It doesn’t require incentives to someone else’s protocol, which are an affront to any respectable physician.
Professor Paul Reitner of the Pasteur Institute in Paris discusses, in Section Six, the UN’s tendency to misrepresent science and why this will be ineffective and counter productive.
Barrack Hussein Obama’s health care program is discussed in Section Seven in a WSJ editorial. It is worth studying. Despite the rhetoric and promises, his team would eliminate choice and advance socialized medicine in our country.
Dr. David Gratzer discusses John McCain’s health care program in Section Eight. Dr. Gratzer, who lived under Canadian Medicare, is well informed with health care programs and gives us the inside story in his WSJ article.
What Is the Answer?
I’ve been part of a working group that included physicians, MBAs, Information Technology and other consultants. We met weekly on Tuesdays from 6:00 to10:00 p.m. for a two-year period designing a health insurance program for the United States and, by extension, the free world. Patients would be involved in the decision-making process at every interface of their health care. It is a variation of the recent consumer-, or more appropriately, patient-directed health care plans on the market. Claims would be Web-based and payment from the insurance company or the patient’s line of credit would clear the next day, much as a check, credit or debit that is deposited. There would be the savings of the insurance biller, since any member of the physician, hospital, x-ray, pharmacy or lab provider’s staff would just simply enter the code and charge the patient’s Web-based account. All charges, as long as they fell within the 90-percentile range, would be paid and electronically deposited into the provider's bank account the next day.
There would be no need for claims review because patients, by paying a percentage of each claim, have a vested interest in reviewing their claims to make sure it is the lowest possible charge. If they were unhappy with the charge, that physician, hospital, x-ray or lab facility would obviously lose all further business from that patient as well as his friends, relatives and business associates. Savings of this simple maneuver was estimated at 15 to 25%, or the cost of the provider’s business office and staff.
This would be coupled with an electronic medical records system with physician entry into medical templates. This would save the cost of a transcription service, which can be significant. Our last transcriber charged by the line, which came to about $5 a page. Thus, a four-page, new-patient medical history and physical exam report could cost $20 in transcription fees. To put this in perspective, our Medicaid reimbursement is $21 per office call. The cost was becoming untenable and so we implemented templates completed by the physician. This chart is also Web based and has eliminated the paper charts, including the filing cabinets and storage facilities, for approximately seven years. Our ten-year cost of chart and x-ray storage was $26,000.
In our plan, all orders were also entered into the Web-based chart, which could be accessed by any provider (laboratory, pharmacy or x-ray facility) the patient chose, allowing full freedom of the marketplace, which is ruthless in finding the lowest cost in the neighborhood and beyond. Thus, the continuous vigorous reducing of health care costs becomes a constant mechanism.
But the Answer Cannot Be Implemented
The group then had an actuary, whose primary job is with a large insurance group, evaluate the business plan. This was a real eye-opener about the status of health insurance or even Medicare reform in our country. He said that this plan would save between 40-50% of all health care costs, which would be reflected in a reduced premium to about half the current rate. But he added that his insurance company and all the large players would vigorously oppose such an entry into the medical marketplace or the health insurance marketplace. They would even use congressional force to try to prevent it.
This was further brought into focus when an entrepreneur looked over the business plan. He was very impressed with the logic, ingenuity and simplified nature of the plan and the totality of the physician-patient interface. He estimated the cost of bringing it to market at $45 million of venture capital plus $10 million in lobbying costs to stop congressional action instigated by the major players in the health care field wanting to prevent any and all marketing efforts.
Is There a Government Solution?
Health reform in the public or political arena is a lost cause. There have been many states that have implemented various efforts to include the uninsured from increasing Medicaid coverage, increasing the CHIP program to grants, subsidies and other slight-of-hand maneuvers. In each case, the cost of health care has increased, but the number of uninsured has not changed or decreased. Thus, government involvement has always increased health care costs but has not ameliorated the problem of extending coverage.
The Solution Lies Outside of the
Health care reform has to come from the private sector. Government is incapable of accomplishing anything that will either solve the problem or reduce the cost. It will only increase the cost and the problem. If the private sector, outside the current vested interests, could invest the projected $45 million ($450 million?) startup costs plus the $10 million ($100 million?) projected lobbying costs to eliminate expensive mandates and placate Congress according to this one entrepreneur, health care reform could occur. This magnitude of such an enormous IT endeavor could only be done with the support of such technology giants as Google or Microsoft. It would then be relatively inexpensive, related to each individual’s wants or needs, save the health insurance industry from government extinction, and place it in the medical marketplace, where there would be vigorous competition to give the best most cost-effective service possible. Otherwise, it just could be Armageddon for the private health care industry. The war of the bureaucrats would then reign supreme.
A portion of this has been previously published in HIU, October 2007.
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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, www.MedLib.ch/
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 entreprise and strict limits to the role of the State
· Grover Norquist, President of Americans for Tax Reform, www.atr.org/ keeps us apprised of the Cost of Government Day® Report, Calendar Year 2007, Fifteenth 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 2007 was July 11th. With July 11th as the COGD, working people must toil on average 192 days out of the year just to meet all the costs imposed by government. In other words, the cost of government consumes 52.6 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.
· Duane Parde, President of the National Taxpayer’s Union, www.ntu.org/main/, keeps us apprised of all the taxation challenges our elected officials are trying to foist on us throughout the United States. Find the organization in your state that’s trying to keep sanity in our taxation system.
· FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, 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, www.aynrand.org/site/PageServer,
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.
Stop the Bailouts September 22, 2008.Washington, D.C.— “Over the last year,” said Yaron Brook, executive director of the Ayn Rand Institute, “the central planners at the Federal Reserve and the Treasury Department have pretended that by bailing out homeowners, then bailing out investment banks, then bailing out Fannie Mae and Freddie Mac, they were wisely ‘steering’ the economy to protect us against some undefined ‘systemic risk.’ But the mounting financial problems reveal that Paulson and Bernanke are as clueless as any other central planners who try to control an entire economy. They are not saving us from anything; they are delaying some of the pain that necessarily follows from a Fed-induced credit bubble, and redistributing that pain to innocent victims. They are punishing responsible individuals and rewarding irresponsible individuals. The bailouts must stop. The government must make clear that from now on, those who are in financial trouble must turn to the private market for help if they are to avoid failure; the government must no longer foist their failures on others, and invite another crisis in the future.”
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Stay Tuned to the MedicalTuesday and the HealthPlanUSA Networks and have your friends do the same.
Articles that appear in MedicalTuesday and HPUSA may not reflect the opinion of the editorial staff. Sections 1-8 are entirely attributable quotes in the interest of the health care debate.
Editorial comments are in brackets.
ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.
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Del Meyer, MD, CEO & Founder
Satyam A Patel, MBA, CFO & Co-Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words of Wisdom: Health
Definition: Soundness of bodily functions; freedom from disease; physical and mental well-being; “the first wealth” –Ralph Waldo Emerson
Health is not a condition of matter, but of Mind . . . –Mary Baker Eddy, Science and Health, 1908
Early to bed and early to rise makes a man healthy, wealthy and wise. –Benjamin Franklin, The Way to Wealth, 1757
Health is not valued till sickness comes. –Thomas Fuller, Gnomologia, 1732
Some Recent Postings
HEALTH CARE CO-OPS IN UGANDA - Effectively Launching Micro Health Groups in African Villages, by George C. Halvorson www.delmeyer.net/bkrev_HealthCareCo-OPInUganda.htm
A CALL TO ACTION - Taking Back Healthcare for Future Generations by Hank McKinnell www.delmeyer.net/bkrev_ACallToAction.htm
PUTTING OUR HOUSE IN ORDER - A Guide to Social Security & Health Care Reform by George P. Shultz and John B Shoven www.delmeyer.net/bkrev_PuttingOurHouseInOrder.htm
This Month in History: October
In this month in 1908, Henry Ford introduced the Model T, known affectionately as Tin Lizzie. Henry Ford pulled automobile manufacturing into the era of assembly lines, interchangeable parts and mass production.
In this month in 1939, the files of history record that Winston Churchill said, “I cannot forecast to you the action of Russia. It is a riddle wrapped in a mystery inside an enigma.” A riddle wrapped in a mystery inside an enigma can still be applied to a few countries today. History does repeat itself.