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HEALTHPLANUSA . NET |
QUARTERLY NEWSLETTER |
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Community
For Affordable Health Care |
Vol VI, No 1, April, 2007 |
Utilizing the $1.4 Trillion Information Technology Industry
To Transform the $1.8 Trillion HealthCare Industry into
Affordable HealthCare
In This Issue:
1. Featured Article: Rebate Financing for Medical Care
2. In the News: Health
Insurance Folly
3. International Medicine: Singapore Moves Further to
Open Market HealthCare
4. Medicare: Negotiated Drug Prices May Not Lower
Costs
5. Lean HealthCare: It’s Time to Allow Doctors to Be
Innovative About Health Care Delivery
6. Medical Myths: They Never Seem to Stop
7. Overheard on Capital Hill: The Debate Goes On and On and On . . . .
8. What's New in US Health Care: Genetic Testing
9. Health Plan USA: Innovative Ideas in HealthCare
* * * * *
1. Feature
Article: Getting back your health, Adam
Smith Institute, www.adamsmith.org
Rebate financing
for medical care, By Philip Booth,
Associate Dean, City University Business School
Executive summary
It is a common belief that
tax funding is the only way to guarantee good healthcare for all. And yet
statistics show that, after 50 years of just such a policy, our National Health
Service (NHS) actually delivers for UK citizens one of the poorest-quality
health systems in the developed world. Like other tax-funded industries of the
postwar era, it is burdened by bureaucracy, politicisation, [sic] low wages, a
lack of customer responsiveness, low rates of innovation, queuing, and
mis-directed resources.
But recent initiatives to
deal with these problems, though sincere, have tried to work within today’s
tax-funding model, instead of asking whether that system itself should be
reformed or even replaced. The Wanless report, for example, did not explore how
the funding base could be widened nor whether fair access could be preserved
through some other method. It did not separate provision from funding, nor
funding from access. In line with this,
current reform strategies have been top-down, centralized attempts to control
and set targets within a closed system, rather than to open up the system to
new methods of funding, and greater customer power.
The majority of people
believe that the NHS has certain desirable attributes. But it is unlikely to be
able to build on them unless the power to control moves away from politicians
and officials to those who use and rely upon its services. There is a simple way to achieve this: a rebate.
The cost of NHS care should be defined, and given back to citizens for them to
decide how to spend as they think best.
That will give them the power to obtain the kind of service they want,
rather than the kind selected for them by the providers.
To work well, the rebate
must be simple. It must be a set amount, which people can take and put towards
the cost of company or individual health and long-term care plans. People should be free to add their own money
to buy more expensive policies if they choose to, or to pocket the difference
if they can find a qualifying plan more cheaply. It would be larger for women and elderly people, reflecting their
greater cost to the NHS; but not people’s personal health status: there would
be no medical. But those who wanted to stay in the state system could do so.
Indeed, if the rebate were slightly below the real cost of NHS the care
foregone by the leavers, the NHS would actually retain more money to focus on
the needs of those who stay.
Coupled with liberalising
reforms in the way NHS services are managed and provided, the rebate would give
everyone at least some incentive to take responsibility for their own health
and the opportunity to access the kind of quality health service they are
currently denied.
To read the entire
lengthy article, please go to www.adamsmith.org/health/index.php/publications/details/getting_back_your_health/.
* * * * *
2. In the
News: Health Insurance Folly, By GRACE-MARIE TURNER, WSJ, March 17, 2007
The
Wall Street Journal published a
commentary that Grace-Marie wrote for them on the folly of expanding SCHIP and
the need to bring more private sector options into the program.
Commentary
Senate
Democratic leaders this week unveiled plans to dramatically expand
taxpayer-funded health insurance to millions more children through the State
Children's Health Insurance Program -- even as 14 states are running out of
money to fund coverage for children in the program now.
Eighteen
governors have blamed the White House for shortchanging the program in its
budget by $10 to $15 billion. But SCHIP isn't in peril because of Washington's
tight purse strings. Many of the governors themselves have led the program
astray.
Launched
in 1997, SCHIP provides health insurance to more than six million enrollees,
primarily children in lower-income families. Originally authorized to spend $40
billion over 10 years, the program is set to expire this year unless Congress
approves new funding.
Senate
Budget Chairman Kent Conrad this week said his plan would expand coverage to
8.3 million more uninsured children and boost spending by $50 billion over the
next five years. Both Republicans and Democrats support SCHIP's
reauthorization, and President Bush called for its renewal in his recent budget
proposal. But one reason SCHIP is in trouble is because it has allowed states
to provide taxpayer-subsidized health care for adults and middle-income
families, even when poor children go without coverage.
That's
right. Despite the program's name, a number of states use SCHIP dollars to
cover adults at the expense of poor children. And most of the states that are
running out of SCHIP money are those that cover adults in their programs. In
2005, for example, 87% of Minnesota's SCHIP enrollees were adults, as were 66%
of those enrolled in Wisconsin's program. In Arizona -- which has one of the
highest rates of uninsured children in the nation -- 56% of those enrolled in
SCHIP were adults. All have their hands out to Washington for more money.
SCHIP
funds are also used, often, to insure children who are not in low-income
families. In New Jersey, for example, SCHIP covers children whose parents earn
up to three-and-a-half times the poverty line -- an amount that exceeds $72,000
a year. Sen. Hillary Clinton and Rep. John Dingell announced this week their
own bill that would subsidize coverage for kids in families earning up to four
times the poverty level -- or nearly $83,000 for a family of four.
States
misuse their SCHIP dollars because the program is structurally flawed. The
federal government gives states more money for those enrolled in SCHIP than for
those covered by Medicaid, which is designed to provide health coverage to
low-income Americans. A simple expansion of SCHIP does not address this flaw. .
.
So
what should be done? First, adults should not be eligible for SCHIP. Covering
adults was never the intent of the program, and states that extend coverage to
adults are diverting funds from the needs of low-income children. Second, SCHIP
should focus on America's poorest families. When the program was created,
congressional leaders explicitly stated that the program should assist only
families who earn up to twice the poverty line. States need to meet the law's
intent.
Finally,
it must be easier for states to utilize SCHIP as a premium-support program. It
is relatively inexpensive to add children to family policies, but by making the
process so bureaucratic, employer-provided plans are underutilized and families
are split into private and public coverage plans.
Congress
has a chance to bring some needed discipline to the program and in doing so,
ensure that it fulfills SCHIP 's core purpose of covering kids first.
Ms. Turner is president of the Galen Institute. www.galen.org
To read the entire article, go to http://online.wsj.com/article_print/SB117408653808140017.html. (Subscription is required.)
* * * * *
3. International Medicine: Singapore Moves
Further to Open Market HealthCare.
Private docs can set own fees as SMA drops guidelines, By Lim Wei Chean, the Singapore Straits-Times,
April 3, 2007
PRIVATE doctors here are free to set their own fees
from now, instead of referring to guidelines drawn up by the Singapore Medical
Association (SMA).
The SMA agreed to withdraw the guidelines during its
annual general meeting on Sunday after receiving word that the guide could be
in contravention of the recently- enacted competition code.
SMA President Wong Chiang Yin told The Straits
Times yesterday that it would be contacting its 4,800 members this week to
alert them to the surprise change.
It is not known how the move will affect the fees
doctors charge, but Dr Wong suggested that doctors refrain from making 'drastic
changes in the short-term' to avoid worrying patients and escalating
health-care costs.
To help patients make fee comparisons, he added that
the SMA will survey private doctors on their fees and publish the results
online.
The fee guide, started in 1987 for both general
practitioners (GPs) and specialists, was intended to inject some transparency
into private medical charges.
It was mooted by the Government to prevent cases of
rampant overcharging. It said it would legislate fees if the medical fraternity
did not take things in hand.
In response, the SMA came out with a guide giving a
range of charges for various services, including what doctors can charge on
weekends and public holidays, and even for issuing a death certificate. . .
However, since the Competition Act was enacted last
year, the SMA has been grappling with the legality of the guidelines.
It consulted its lawyers and was told the guidelines
could be illegal.
However, the SMA had several misgivings about
withdrawing them. One concern was whether patients with small claims would have
an avenue for redress if the guidelines were withdrawn,
Dr Wong also argued that patients, especially those
who need specialist treatment, are not like other consumers who 'shop around'
for better value for money.
The association then decided to write to the
Competition Commission for clarification.
However, the commission reiterated a section of the
Act stating that 'recommendations of a trade association in relation to
price...may be considered to be price-fixing, regardless of the form it takes'.
When contacted yesterday, the chairman of the
Government Parliamentary Committee for Health Halimah Yacob expressed dismay at
the change and said: 'Health care is an important public good that should be exempted
from the competition code. . .
But the executive director of the Consumer's
Association of Singapore Seah Seng Choon felt that the withdrawal is 'good in
principle as it endorses the concept of free competition'.
He said doctors should display their fees clearly in
their clinics so patients know the charges before they decide to seek
treatment. . . .
The Health Ministry told The Straits Times yesterday
that under its guidelines for private hospitals and medical clinics, doctors
are encouraged to publish their consultation charges before seeing patients.
A separate law under the Private Hospitals and Medical
Clinics Regulations also requires hospital managers to inform patients before
or on admission the estimated total charges for their stay.
It said it will continue to publish pricing data and
historical price trends on its website.
www.sph.com.sg/newspapers/straitstimes.html
Government Medicine does not give timely access to
healthcare, it only gives access to a waiting list.
* * * * *
4. Medicare:
Negotiated Drug Prices May Not Lower Costs, by Alain Enthoven
and Kyna Fong
Rep. Nancy Pelosi has promised that within its first 100 hours the
Democrat-controlled House will repeal the ban preventing Medicare from
negotiating directly with pharmaceutical companies. She must expect this
legislation to bring down drug prices dramatically. However, it is not obvious
that allowing the government to negotiate with pharmaceutical companies will
lead to lower prices than those achieved by private drug plans. There are
several good reasons why not.
Market Power versus Bargaining Power. Negotiations are a bargaining process. The
relative balance of bargaining power determines at which price the deal is
struck.
People often confuse market power with bargaining power. The
thinking goes, the larger the share of the market the buyer represents, the
greater the bargaining power and thus the lower the prices negotiated. That
line of reasoning fails with drugs, however, because the seller is frequently
a monopolist with an exclusive patent. That means the seller cannot be
threatened with replacement by a substitute. Instead, the only threat is that
the two sides fail to agree and the drug is withheld from the market.
Rather than market share, a party’s bargaining power is determined
simply by the ability to say no — to walk away from the table without an
agreement. Whether the government or a private drug plan has greater bargaining
power is not clear. Who can walk away more easily and declare some brand-name
drug will not be covered on the formulary? Private plans like Kaiser Permanente
or UnitedHealth Group are able to negotiate deep discounts with pharmaceutical
companies precisely because of the plans’ ability to say no — to pay for some
drugs and to exclude others, allowing the market to judge the resulting
formulary. But when the government negotiates, there are few drugs it can
exclude without facing political backlash from doctors and the Medicare voters.
Price Discounts. If the government acts as one large buyer for Medicare, the cost
to pharmaceutical companies of granting discounts becomes greater. As a
result, drug companies are not able to offer discounts to the government as
large as they have previously offered to some individual plans. When
individual private drug plans are negotiating with pharmaceutical companies,
those companies have the power to “price discriminate,” charging lower prices
to some plans and higher prices to others. This ability makes large discounts
possible for some plans. Government consolidation of demand into one entity
that is given a single discount is similar to forcing all discounts to all drug
plans to be the same. Other things equal, this leads to higher, not lower,
prices.
Medicaid Discounts. Experience with Medicaid shows what can happen when one buyer’s
price discount is linked to the discounts of other buyers. Medicaid’s
best-price rule states roughly that Medicaid will be granted the lowest price offered
to any drug buyer. If that price is not low enough, Medicaid receives a fixed
discount off the average price. In effect, the best-price rule transforms all
privately negotiated discounts into public discounts for Medicaid.
Research by academics, along with a slew of anecdotal press
reports, suggests that since the passage of the Medicaid best-price rule in
1990, prices paid by the private sector have risen. According to research by
Yale University economist Fiona S. Morton, the best-price rule has had a small
but noticeable effect on the prescription drug prices paid by non-Medicaid
purchasers:
■
Prices paid by the
public for brand-name drugs with generic competitors have increased an average
of more than 4 percent. [See Figure I.]
■
Price increases have
been highest for drugs for which Medicaid purchases comprise a larger share of
sales.
■
Drug discounts to
non-Medicaid buyers have fallen.
■
Manufacturers have
also compensated for the lower prices granted to Medicaid by changing product
mix and pricing strategy (for instance, by reducing per-unit price breaks on
larger drug packages).
By the end of the first year under the best-price rule, federal,
state and local governments saved an estimated $150 million per quarter in
Medicaid expenditures. But given the resulting price increases for non-Medicaid
buyers — including other government drug purchasers, such as the Veterans’
Administration (VA) — the savings to society are not at all clear.
Restricting Access to Drugs. What about the argument that government negotiations lead
to lower prices in Canada, Britain and other countries? While those governments
may obtain lower prices than the public pays in the United States, the real
question is the following: Do those governments negotiate lower prices than
what would be negotiated if smaller groups of buyers were able to deal
individually with pharmaceutical companies?
In other countries health care systems also lower their drug bills
by controlling entry and restricting formularies. But with the expansion of the
Internet and unrestrained information flow, patients are challenging these
restrictions. A well-publicized legal battle by a woman against a British
National Health Service (NHS) decision not to cover Herceptin for early-stage
breast cancer has compelled the NHS to reverse its original decision and offer
coverage for that drug.
In the United States, the VA’s tight control over drug costs is
often cited as a model for Medicare to follow. However, it is important to
recognize that the main tool the VA employs to control drug costs is
restricting the set of drugs that are covered. As a result, less than one-third
of the drugs available to Medicare patients are available to VA patients. [See
Figure II.]
Government Interference. Finally, one may consider the possibility that, rather than have
the market determine prices, perhaps the government can do better by setting
reimbursement levels itself. But how can the government determine what prices
appropriately reimburse pharmaceutical companies for their research and
development efforts? How can the government determine what prices will
encourage the right levels of future innovation?
Government interference and negotiations inevitably encourage
private parties to try to influence the process through political lobbying and
campaign contributions — activities at which pharmaceutical companies have
proven quite adept.
Conclusion. Congressional
Democrats need to be careful in trying to make the logical leap from market
share to bargaining power. Empowering the government to negotiate with
pharmaceutical companies is not necessarily equivalent to achieving lower drug
prices. In fact, neither economic theory nor historical experience suggests
that will be the outcome.
Alain Enthoven is a professor emeritus at the Graduate
School of Business at Stanford University, where Kyna Fong is a doctoral
student in economics. A version of this article previously appeared in The Wall Street Journal.
To read the entire article, please go to http://cdhc.ncpa.org/.
Government is not the solution
to our problems, government is the problem.
- Ronald Reagan
* * * * *
5. Lean
HealthCare: Lessons
from Jim Womack,
Chairman, Lean Enterprise Institute
Health
Care has so many out of control requirements placed on it by government,
hospitals, insurance carriers and non-medical controlled HMOs that the very
people that are capable of thinking about improvement, have no time to be
innovative. It’s time to throw off the shackles placed on our profession that
increases the cost of our services and decreases their value.
Our final hypothesis is
that most managers have learned to see muda (waste) in the individual
steps of their value streams. But they fail to see, much less to tackle, the
problems of mura (unevenness) and muri (overburden) that create much of
the muda. For example, we routinely see managers with so many
out-of-control conditions to work around that they have no time left over for
thinking about improvement. They are proud of how hard they work and what they
manage to achieve in chaotic conditions. Yet the press of the exceptional—the
thing “gone wrong”—crowds out the pressing need for true problem solving. As a
result few problems ever get solved.
Where does this muri
come from? Usually it is created within the organization rather than externally
by the customer, as most managers seem to believe. Actions by managers in one
part of the organization cause unevenness (mura) in the activities of
managers and employees in other parts of the organization. And this causes muri
– the overburden most managers feel most of the time. . . It follows that to
make real progress in organizational transformation managers need to address
all three Ms – muda, mura, and muri – at the same time.
As I said at the outset,
these are simply hypotheses. We’ll inform everyone of our findings. But in the
meantime I hope you will devise your own hypotheses about the most effective
methods for lean transformation and put them to the test. And I hope you will
be willing to share your findings with the Lean Community around the world.
Best regards, Jim Womack, Chairman and Founder, Lean
Enterprise Institute
* * * * *
6. Medical
Myths: Myths from America – They Never Seem to Stop
NEW YORK:
You don’t have to read very far into the papers, or go to the doctor much, to
find that the American health care system is on the precipice of disaster, with
costs rising, ever more uninsured people, and high numbers of deaths due to
errors or complications - 98,000 of them a year, according to a widely cited
estimate by the Institute of Medicine of the National Academy of Sciences.
We spend twice
as much ($6,000 a year a year for every man, woman and child) and have worse
results than some European countries. [Be sure to see the featured article from
the UK in section 1.]
Costs are going
up three times as fast as inflation, which means that fewer companies can
afford to buy health insurance for their employees, which means in turn that
more and more people are uninsured. [Being uninsured is a product of health
care being laid on backs of employers. It has to be given back to the employees
for innovation and cost control.]
Contrary to the
view of many outside this country - that millions of Americans get no care at
all - the uninsured do get treated, paying some of the bills out of pocket, or
not paying at all. But the unpaid expenses are then passed along in the form of
higher costs, leading to more people who can’t get insurance, and on and on. .
. [Getting on a waiting list for years
amounts to no care at all since many die on such waiting lists.]
Not
surprisingly, as a result, even a Republican president like George W. Bush is
talking about health care reform, and so are the Democratic presidential
candidates. Under the circumstances, it seemed that a small personal story
about a colonoscopy might have some bearing.
A colonoscopy is
a routine check for colon cancer that people over 50 are supposed to have every
five years so that any polyps or other growths can be removed before they have
become harmful and vastly more expensive to treat. In the spirit of smart
preventive medicine, I went a few weeks ago to my doctor to have the procedure
done.
All went well,
as it usually does in the higher echelons of American medicine, where doctors
are top-notch and the treatment delivered in immaculate conditions. There is
something new in the universe of colonoscopies, moreover, at least in my
doctor’s office: the procedure there is now done under anesthesia, so the
considerable, if momentary, discomfort that it used to cause has been
eliminated.
And my medical
insurance - paid for by my employer - covered the entire cost. [Therein lies
the problem. If Bernstein had to pay for this diagnostic study, he would have
researched the medical need and probably foregone the colonoscopy since many
American Gastroenterologists feel the procedure is vastly over rated and
overdone.]
Still there is that cost and
it was high: the insurance company statements showed that the anesthesiologist
charged, and was paid, $1,400 for the half-hour procedure. The internist who
actually performed the colonoscopy sent a bill for $1,000, but accepted the
insurance company’s payment of $800. [In my community there is no
anesthesiologist present. . . If Mr Bernstein were involved in paying for the
colonoscopy, even if only 20 percent of the cost, he would make sure these huge
fees would be unacceptable. Only in our current socialized bureaucracy in
America can this exist. It would not be tolerated if we were in a private or
free-market environment.]
* * * * *
7. Overheard
on Capital Hill: The Debate Goes On and On and On . . . .
There is a continuing
debate on Capital Hill by one party about pulling troops out of Iraq and using
the money to take over the US Health Care Program. The other party is pointing
out that there has been a monthly average of 160,000 troops in the Iraq theatre
of operations during the last 22 months, and a total of 2,112 deaths. That
gives a firearm death rate of 60 per 100,000 soldiers.
The firearm death rate in
Washington D.C. is 80.6 per 100,000 persons for the same period. So the
opposition is pointing out that you are about 33% more likely to be shot and
killed in the U.S. Capital than you are in Iraq. They are suggesting a
different conclusion:
The
U.S. should pull out of Washington.
* * * * *
8. What's New in
US Health Care: Genetic Testing
Sara is 29 years old. She has a 33-year-old sister, a
mother and a maternal aunt who all died of breast cancer. There is a high
likelihood that she has a genetic form of breast cancer.
The good news, if there is any, is that if Sara has a
genetic predisposition for breast cancer, there are steps she might want to take
to decrease the chance it will cause her death. Some of these interventions are
dramatic, including the removal of both breasts before they develop cancer.
Of course, she wouldn't want to take these steps if
she doesn't have a genetic predisposition. But Sara is stuck. She works in a
small business, and if she gets tested and the result is positive, she can be
denied health and life insurance coverage for the rest of her life. Insurance
companies argue that the presence of the gene should be considered a
"pre-existing condition" even though Sara is, and has always been,
extremely healthy.
It appears Congress will again consider a bill to
prevent discrimination against those with, or at risk for, a genetic condition.
This will be the seventh time the issue has come before Congress.
The Genetic Information Nondiscrimination Act would
make it illegal for the insurance industry to deny a healthy woman such as Sara
insurance, or for employers to deny her employment based solely on genetic test
results. The past seven times, the bill failed in one chamber or the other,
opposed by Republican leaders. At least for now, the bill seems to have
bipartisan and public support. Opposition comes from the U.S. Chamber of
Commerce. It says the bill imposes too large a burden on employers.
If we had a national health insurance plan, this
wouldn't be an issue. * In addition to the myriad other benefits that would
come from a national health plan, not having to worry about insurance
discrimination would make conducting genetic research far easier and a benefit
to all Americans.
There are 1,300 genetic tests used today to identify
genetic conditions, up from just 100 tests five years ago. Genetic testing will
most certainly increase as we discover new links between specific genes and the
diseases they cause.
Doctors often order these genetic tests without
carefully discussing with their patients the ethical and social implications of
a positive test. **
Admittedly, in many cases, I don't discuss the pros
and cons of ordering a routine urine test or a complete blood count. My
presumption is that when a patient comes to the doctor, he wants to be involved
in significant decisions, but not at the level of ordinary diagnostic tests.
Genetic testing is different. While the test itself
involves a simple blood draw, and the doctor may wish to order the test for a
medically sound reason, the social implications need to be carefully discussed
with the patient. In these discussions, I have seen some women like Sara decide
against testing for fear the result will fall into the wrong hands. I have seen
other women not give the decision a second thought: "Of course I want to
know if I carry a cancer gene. Why are you asking me?"
As we discover more about genetics, I suspect most of
us will end up with some sort of genetic predisposition to illness. Carried to
an extreme, isn't life itself a predisposition to death?
To read the full article, please go to www.sacbee.com/107/v-print/story/142542.html.
[* Others would argue that if the government-funded
health care and thus genetic testing, the results would essentially be in a
national data registry controlled by HIPAA regulations. This would allow most
government agencies access, including tens of millions of employees. But
doctors and those that need to know in order to take care of these very
patients have difficulty in accessing this information. Genetic testing can
only be kept confidential in a private healthcare system where each doctor
protects the medical information, including test results of all of his/her
patients.]
[** In our
experience, private doctors discuss the ethical and social implications of a positive test with their
patients much more thoroughly than government or bureaucratic doctors and
understand the importance of keeping this information out of the insurance data
registry.]
* * * * *
9. Health
Plan USA: Premiums Should Be Based on Self-Induced Risky Behavior
One of the
large issues in the privatization of health care is insurability. Having the
worker own his own insurance plan and taking it with him will keep him/her
insured. But is there a better way?
Our research
group is trying to obtain data on using a health-risk model instead of a
disease model. In other words, a patient with diabetes is essentially
uninsurable. Likewise, a patient with cancer or arteriosclerotic heart disease
post a myocardial infarction. But can we obtain the necessary premiums from
those who are increasing their risk for heart disease, or cancer or diabetes
through personal habits? Why should the person who tries to live a healthy life
pay premiums to insure those that smoke, drink excessively, eat morbidly or
live a risky lifestyle? The risk of these self-induced diseases can be calculated
and the premiums adjusted accordingly.
For example,
one who smokes two packs a day will easily double his health-care costs because
of bronchitis, emphysema and lung cancer. Why shouldn’t he pay twice the
premium of the nonsmoker? Those who have congenital emphysema without any
cigarette history would then obtain insurance under the standard premium.
The person who
has a body mass index of 40 will have twice (estimated) the health-care costs
of a person with a BMI of 20. Shouldn’t that be reflected in the premium before
they get the complications of obesity rather than when they acquire diabetes,
etc?
Such a premium
structure would have the salutary benefit of decreasing cigarette consumption
or over-eating more than any cigarette withdrawal clinic or weight-loss
program.
If there is
any support for such a program, we would love to hear from you.
* * * * *
10. Restoring
Accountability in Medical Practice by Non Participation in Government Programs and Understanding the
Devastating Force Of Government.
·
Lew Rockwell's premier free-market site can be found at www.lewrockwell.com. Be sure
to read some of his lectures to medical groups. To learn how state medicine
subsidizes illness, see www.lewrockwell.com/rockwell/sickness.html;
or to find out why anyone would want to be an MD today, see www.lewrockwell.com/klassen/klassen46.html.
·
PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY
with Larry
Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/.
Dr Huntoon does not allow any HMO or government interference in your medical
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numbers required on claim forms) in our practice, I have been able to keep our
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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
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* * * * *
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Del Meyer
Del Meyer, MD, CEO & Founder
HealthPlanUSA, LLC
6620 Coyle Ave, Ste 122, Carmichael, CA 95608
Words
of Wisdom
LABELS: No one is just one thing: The label that’s been given to
them, the definition that one has accepted and lives within. Nonetheless, so
much of what we work and live by seems based on these seemingly transparent
assumptions. . . We must use social
labels and self-defining names as they should be used, as convenient constructs
to get a handle on the shifting world, to be replaced by more suitable ones as
the world shifts again, as we shift again. –Philip Kan Gotanda, in the preface
to No More Cherry Blossoms.
MANAGEMENT IS NO MORE A SCIENCE THAN IS MEDICINE: BOTH ARE
PRACTICES. The modern enterprise is a human and social organization.
Management as a discipline and as a practice deals with human and social
values. To be sure, the organization exists for an end beyond itself. In the
case of business enterprise, the end is economic; in the case of the hospital,
it is the care of the patient and his or her recovery; in the case of the
university, it is teaching, learning and research. To achieve these ends, the
peculiar modern invention we call management organizes human beings for joint
performance and creates social organization. But only when management succeeds
in making the human resources of the organization productive is it able to
attain the desired outside objectives and results.
Some
Related Postings
THE BUSINESS OF MEDICINE by J K Silver, MD, www.delmeyer.net/bkrev_BusinessofMedicine.htm
www.healthplanusa.net/NewsLetterIntro.htm
www.healthplanusa.net/January07.htm
www.healthplanusa.net/October06.htm
www.healthplanusa.net/July06.htm
www.healthplanusa.net/GrameenBank.htm
Global Advances in Health Care
Aphorisms
& Anecdotage
I care not who writes
the nation’s laws, if I can write its songs.
Music is the
international language because everybody responds to its notes.
The song is
ended but the melody lingers on.
Let’s face the
music.
Some of the
strongest people in the world can’t carry a tune.
The orchestra
played Tschaikowsky’s Romeo and Juliet overture, and the longhaired elderly man
in the audience wept and wept. “You must be an incurable romantic,” said the
lady next to him. “No,” he said, “I’m a musician.”
Hell is full of
musical amateurs. Music is the brandy of the damned. GB Shaw, 1903