Community For Affordable Health Care

Vol X, No 1, April, 2011


Transforming the $3 Trillion HealthCare Industry into Affordable HealthCare

By Utilizing the $2 Trillion Information Technology Industry

Moving through innovation from a Vertical to a Horizontal Industry

Thus eliminating $1 Trillion wasted

Insuring every American without spending the Extra $1Trillion Projected.

To purchase a copy of the business plan, become an entrepreneur,
and changed the course of history, go to the bookstore at

In This Issue:

1.         Featured Article: A Member of the European Parliament’s Warning to America

2.         In the News: On Tax Day, Friday,  April 15, 2011, Atlas Shrugged Opens

3.         International Healthcare: NHS breaches target for hospital waits By Nicholas Timmins,

4.         Government Healthcare: Medicare’s Benefits exceed Contributions by 300 Percent

5.         Lean HealthCare: Lean HealthCare requires defunding ObamaCare

6.         Misdirection in Healthcare: Hospitals taking over private practices

7.         Overheard on Capital Hill: After the Welfare State

8.         Innovations in Healthcare: How to become an Entrepreneur?

9.         The Health Plan for the USA: A graded copayment on every level of service

10.        Restoring Accountability in HealthCare by Moving from a Vertical to a Horizontal Industry:

The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 8th Annual World Health Care Congress will be held April 4-6, 2011 at the Gaylord Convention Center, Washington DC. For more information, visit The future is occurring NOW.

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1.         Feature Article: A Member of the European Parliament’s Warning to America

The perils of following us toward greater regulation, higher taxes and centralized power.


On a U.S. talk-radio show recently, I was asked what I thought about the notion that Barack Obama had been born in Kenya. "Pah!" I replied. "Your president was plainly born in Brussels."

American conservatives have struggled to press the president's policies into a meaningful narrative. Is he a socialist? No, at least not in the sense of wanting the state to own key industries. Is he a straightforward New Deal big spender, in the model of FDR and LBJ? Not exactly.

My guess is that, if anything, Obama would verbalize his ideology using the same vocabulary that Eurocrats do. He would say he wants a fairer America, a more tolerant America, a less arrogant America, a more engaged America. When you prize away the cliché, what these phrases amount to are higher taxes, less patriotism, a bigger role for state bureaucracies, and a transfer of sovereignty to global institutions.

He is not pursuing a set of random initiatives but a program of comprehensive Europeanization: European health care, European welfare, European carbon taxes, European day care, European college education, even a European foreign policy, based on engagement with supranational technocracies, nuclear disarmament and a reluctance to deploy forces overseas.

No previous president has offered such uncritical support for European integration. On his very first trip to Europe as president, Mr. Obama declared, "In my view, there is no Old Europe or New Europe. There is a united Europe."

I don't doubt the sincerity of those Americans who want to copy the European model. A few may be snobs who wear their euro-enthusiasm as a badge of sophistication. . . .

All right, growth would be slower, but the quality of life might improve. All right, taxes would be higher, but workers need no longer fear sickness or unemployment. All right, the U.S. would no longer be the world's superpower, but perhaps that would make it more popular. Is a European future truly so terrible?

Yes. I have been an elected member of the European Parliament for 11 years. I have seen firsthand what the European political model means.

The critical difference between the American and European unions has to do with the location of power. The U.S. was founded on what we might loosely call the Jeffersonian ideal: the notion that decisions should be taken as closely as possible to the people they affect. The European Union was based on precisely the opposite ideal. Article One of its foundational treaty commits its nations to establish "an ever-closer union."

From that distinction, much follows. The U.S. has evolved a series of unique institutions designed to limit the power of the state: recall mechanisms, ballot initiatives, balanced budget rules, open primaries, localism, states' rights, term limits, the direct election of public officials from the sheriff to the school board. The EU places supreme power in the hands of 27 unelected Commissioners invulnerable to public opinion.

The will of the people is generally seen by Eurocrats as an obstacle to overcome, not a reason to change direction. When France, the Netherlands and Ireland voted against the European Constitution, the referendum results were swatted aside and the document adopted regardless. For, in Brussels, the ruling doctrine—that the nation-state must be transcended—is seen as more important than freedom, democracy or the rule of law. . .

Why is a European politician urging America to avoid Europeanization? As a Briton, I see the American republic as a repository of our traditional freedoms. The doctrines rooted in the common law, in the Magna Carta, and in the Bill of Rights found their fullest and most sublime expression in the old courthouse of Philadelphia. Britain, as a result of its unhappy membership in the European Union, has now surrendered a large part of its birthright. But our freedoms live on in America. . .

So you can imagine how I feel when I see the U.S. making the same mistakes that Britain has made: expanding its government, regulating private commerce, centralizing its jurisdiction, breaking the link between taxation and representation, abandoning its sovereignty.

You deserve better, cousins. And we expect better.

Mr. Hannan is a member of the European Parliament. This essay is adapted from the Encounter Books Broadside, "Why America Must Not Follow Europe."

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2.         In the NewsOn Tax Day, Friday,  April 15, 2011, Atlas Shrugged Opens

The time has arrived!On Friday, April 15, the Atlas Shrugged movie will open on more than 300 screens around the country. Find the theater closest to you (and demand it in your city, if it’s not already there) by going of us who love Ayn Rand’s novels should bring our friends to see the movie on the opening weekend. This is hugely important; it shows theater owners how much demand there is for this independently produced and distributed movie based on Ayn Rand’s revolutionary novel. Equally important, though, is to go back the following weekend—with even more friends. This helps demonstrate the movie’s momentum in no uncertain terms, and will draw even more theaters on board.If you haven’t already seen the trailer and the excellent preview clips (‘Henry Rearden Comes Home’ and ‘Dagny Taggart Confronts the Union’) from the movie, you can watch those here: the show. Meantime, to help capitalize on this new wave of publicity for Ayn Rand’s writings, we’re hard at work building new functionality for the Atlasphere, including better search functionality, enhanced (and free) social networking options, and some innovative ways of sharing our enjoyment of Ayn Rand’s ideas. We’ll have more updates for you on this front shortly.
You may also wish to read Don Luskin’s review in the WSJ on “Atlas Shrugged.”

Remembering the Real Ayn Rand

The author of "Atlas Shrugged" was an individualist, not a conservative, and she knew big business was as much a threat to capitalism as government bureaucrats.


Tomorrow's release of the movie version of "Atlas Shrugged" is focusing attention on Ayn Rand's 1957 opus and the free-market ideas it espouses. Book sales for "Atlas" have always been brisk—and all the more so in the past few years, as actual events have mirrored Rand's nightmare vision of economic collapse amid massive government expansion. Conservatives are now hailing Rand as a tea party Nostradamus, hence the timing of the movie's premiere on tax day. . .

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3.         International Healthcare: NHS breaches target for hospital waits By Nicholas Timmins,
FT, Public Policy Editor

Andrew Lansley’s bad week got no better on Thursday as data showed that the National Health Service in England has breached a pledge that no patient need wait more than 18 weeks for hospital admission, for the first time since the coalition government was elected.

In February 89.8 per cent of patients were admitted for treatment within 18 weeks when the official target is 90 per cent. The average wait for admission has also risen since the election, as have the absolute numbers waiting more than 18 weeks . . .

In February, the latest figures show, only 89.8 per cent were admitted within the target time and more than 39,500 were waiting beyond 18 weeks.

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

In America, everyone has access to HealthCare at all times.

How can anyone with an acute appendix or gall bladder wait 18 weeks without dying?

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4.         Government Healthcare: Medicare’s Benefits exceed Contributions by 300 Percent

Obama's 'Conversation' on Entitlements


A couple retiring last year paid $109,000 into Medicare but can expect $343,000 back from the system.

Nobody should be surprised that public-sector workers in Wisconsin and elsewhere are fighting to preserve every penny of their promised benefits.

Nobody should be surprised that state governors—and it doesn't matter which party—are trying to trim those privileges and benefits. . .

News reporters may be naïve, and some of the protesters may pretend to be. But this fight was penciled in long ago, when politicians and union leaders made the strategic decision to negotiate benefits without negotiating for the funding to make good on them. The mock shock and horror is all the more laughable given that events in Wisconsin are a perfect microcosm of the battle that every sentient American knows, and has known for a generation, awaits Medicare and Social Security.

In keeping with the theatrics of naïveté, President Obama now calls for "beginning a conversation on entitlements." One wonders what it was, then, that G.W. Bush began at the 2004 Republican convention, or what thinkers and activist groups that have been pushing visions of entitlement reform for decades have been doing.

Has the president not heard of the private sector's pioneering work on "defined contributions"? Or Bill Clinton's landmark Medicare commission in 1999? One might as well wonder what pain is coming to those Obama followers who have yet to suspect their thoughtful liberal might be a visionless apparatchik.

Don't doubt that Mr. Obama's real impulse . . . is to let things ride and then simply, amid a crisis, start slashing benefits for the "rich" while also raising taxes on "the rich." Unspoken has been a Democratic assumption that an aging electorate, in a crisis, would be willing to tax itself to the hilt to prop up an unreformed or barely reformed Social Security and Medicare. . .

Medicare is the real killer. According to Eugene Steuerle of the Urban Institute, an average couple retiring last year can look forward to consuming Medicare benefits with a present value of $343,000, having paid Medicare taxes with a present value of $109,000.

And don't let that figure get your hopes up, because even that $109,000 is not available today. That money was spent long ago. The government's trust funds are a fraud. Indeed, by some large amount, society missed out over many decades on domestic savings and investment that would have taken place had workers not been relying on unfunded government promises to support them in retirement. . .

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

- Ronald Reagan

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5.         Lean HealthCare:  Lean HealthCare requires defunding ObamaCare

Viewpoints: ObamaCare should be defunded – now

Sally Pipes – Special to THE BEE – Friday, Apr. 01, 2011

Last week, the Obama administration's top lawyer, acting Solicitor General Neal Katyal, asked the Supreme Court not to honor Virginia Attorney General Ken Cuccinelli's request to fast-track his state's constitutional challenge to the federal health care law. Katyal argued that there was "ample time before 2014" – the year by which all Americans must have health insurance – so the high court need not rush to hear the case.

Unfortunately, between now and then, the majority of the Patient Protection and Affordable Care Act's other provisions will take effect. Implementing those provisions will require billions of dollars – money that could be for naught if the Supreme Court invalidates the law.

With this year's budget deficit near $1.4 trillion, that's also money we don't have. Now is the time to defund the law – not just because the law's fate is uncertain, but because we can't afford to implement it.

At least 44 states and the District of Columbia are facing deficits that total $112 billion over the next year. They may welcome the initial seed money that Obamacare provides to expand Medicaid – the joint federal-state health insurance program for the poor – and fulfill other provisions of the law. But they'll be left holding the bag in just a few years, when the federal subsidies run out.

A report commissioned by Sens. Orrin Hatch, R-Utah, and Fred Upton, R-Mich., projects that Obamacare "will cost state taxpayers at least $118.04 billion through 2023" thanks to the required expansion of Medicaid. When it passed, the health care reform law contained $105 billion in approved funding through 2019. This year, the legislation is set to spend $23 billion.

Congress could put a stop to these expenditures. Republicans have professed their opposition to the law, but they appear to be balking at the prospect of actually cutting off funding.

That's too bad, as several of Obamacare's newly established programs have no business drawing on taxpayer funds. . .

In the past, Berwick has expressed admiration for government-run, single-payer health care systems – which control costs by rationing care. American patients accustomed to receiving the world's most advanced care should hope that the Center for Innovation doesn't deem single-payer a payment model worth testing.

Another reform worthy of the chopping block is the minimum medical loss ratio, which requires that health insurance firms spend 80 percent of premiums in the individual and small-group markets – and 85 percent of premiums in the large-group markets – on medical claims.

Minimum medical loss ratios will cripple competition by forcing smaller insurers that don't have the economies of scale needed to comply with the rules from the marketplace. Indeed, research from PricewaterhouseCoopers has shown that residents of states with minimum loss ratios face lower levels of competition – and higher prices – than their counterparts in states without them. . .

Absent action, the nonpartisan Congressional Budget Office projects that from 2014 to 2023, America will spend $2 trillion – a little over 14 percent of the national debt – on the president's health care reform effort.

Simply put, the American people can't afford Obamacare – and would like a defund.

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

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6.         Misdirection in Healthcare: Hospitals taking over private practices

by Manoj Jain, MD, MPH

A decade and a half ago, when I moved to Memphis, I proudly hung a sign outside an office I shared with another doctor. It had my name followed by an MD. I had started my own small business as a solo practitioner in medicine.

Over the years, the practice has grown. I now have several employees and my own office, with the names of several other doctors alongside mine on the sign.

But across Memphis and the nation, health care delivery systems are shifting, and doctors are radically changing how they practice medicine. In a matter of a few years, small and large medical practices are crumbling, lumping, merging, or rebuilding — depending on one’s perspective.

According to the Medical Group Management Association, in 2005 more than 65 percent of medical practices were physician-owned. Within three years that figure had dropped to 50 percent, and by now I suspect it is much lower.

So why all these changes, and ultimately what will it mean for patients?

For one, providing health care is becoming increasingly complex. Keeping up with innumerable regulations from private insurers and the government, transitioning to electronic medical records (EMR) and caring for a growing population of chronically ill patients make it nearly impossible for a full-time practicing doctor to manage patients and a practice. For example, last year, I invested $15,000 in an EMR only to scrap it because it did not connect efficiently with hospital computer records.

There is another more significant reason for the demise of physician-owned practices. Two years ago, a cardiologist educated me over a coffee at Starbucks about the way Medicare was changing its payments. For the technical component of an echocardiogram, a hospital-outpatient department receives $450, while a physician-owned cardiology office gets $180. “It doesn’t make sense. We are going to go out of business.” According to rumors, that’s what was happening with many large private practices that had invested heavily in technology and diagnostic equipment. With the cuts, the practices were not sustainable.

So why did Medicare cut payment to doctors for office procedures? Many studies have found that if doctors have medical equipment in their offices, they tend to overuse it. One study showed that doctors who have an MRI machine in their office tend to order three times more MRI scans per 1,000 office visits compared to other physicians. For a cardiologist it was 2.6 times more cardiac echoes, according to a 2009 Medicare Payment Advisory Commission’s report. Overuse of imaging studies is a major factor contributing to skyrocketing health care costs.

So I asked a few doctors why did Medicare not cut payments to the hospitals. Some say, “That is coming soon,” while others say, “The hospital lobby was stronger than the doctor lobby.”

Whatever the case, the new health care landscape gives hospitals greater control over local health care resources. But as one hospital CEO told me, “I really don’t want to take over doctor practices. Managing doctors is like herding cats. But there is no choice.” . . .

Manoj Jain is an infectious disease physician and contributor to the Washington Post. He can be reached at his self-titled site, Dr. Manoj Jain.

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Well-Meaning Regulations Worsen Quality of Care.

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7.         Overheard on Capital Hill: After the Welfare State

The moral price of dependence on government is even higher than the financial cost.

That crashing sound you hear? It's the sound of welfare states in collapse. From Albany to Athens, all but the dimmest observers now recognize that the model we've been following has run aground—morally, socially and fiscally. Less clear is what's going to replace it.

Today, House Budget Committee Chairman Paul Ryan gives a hint at the possibilities. Over the next few weeks, the Beltway will consume itself defending or defenestrating his numbers and projections. Yet Mr. Ryan's budget is less about dollars and cents than the assumption behind them: that the best way to help Americans is to increase their access to the market rather than try to shield them from it.

The implications of that assumption are fleshed out in a prescient essay in the spring issue of National Affairs called "Beyond the Welfare State." Written by a former White House colleague of mine, Yuval Levin, it argues that the moment is ripe for conservatives to address the primary failure of the welfare state: a vision of man that is too narrow, tethered to a trust in government that is too high.

Conservatives, he says, reject the notion both that capitalism is dehumanizing, and that you increase social solidarity by increasing middle-class dependence on government. A conservative vision would consequently put a premium on upward mobility, promote personal responsibility, and in general regard institutions such as church and family as assets to be embraced rather than obstacles to be overcome. In short, as Mr. Levin says, it would "insist on the distinction between a welfare program and a welfare state."

You can see what Mr. Levin is driving at in Mr. Ryan's pitch for Medicare reform. Under the existing system, the government simply pays for its recipients' health care. The result is an increasingly unwieldy bureaucracy that sets prices, imposes thousands of pages of regulation, and is growing far faster than our ability to pay for it.

Mr. Ryan proposes a simple but dramatic shift: helping people afford private coverage. Under this reformed system, seniors would have their private premiums subsidized, and the poorest would get the largest subsidies. The hope is that over time it would have the opposite effect of the present system. Instead of increasing the dependence of the middle class, it would help make all seniors consumers.

Alas, bringing the middle classes into government programs has been a key aim of the social democratic state. We all know that has helped raise the financial costs to levels we can no longer afford. The moral and social price of expanding government, however, has been even more costly.

In a remarkable blog post at the American Interest, Walter Russell Mead notes that today African-Americans are fleeing the "urban paradises of liberal legislation and high public union membership" for the suburbs and job-creating red states. Another way of putting it is that the progressive policies and programs that were supposed to advance equality and opportunity have instead left blighted communities and blighted lives in their wake. This he calls "the most devastating possible indictment of the 20th century liberal enterprise in the United States."

It didn't have to turn out this way. Somewhere along the line, liberals came to accept that the only path to their goals was through government. Huge bureaucracies and powerful constituencies grew up around that idea, turning the private sector into something that existed only to be squeezed for the necessary funding.

Ironically, in their obsession with government, American liberals continue to overlook their greatest strength: their ability to set goals for our society. . .

Liberals tend to oppose even these improvements. Sadly, they've become wed to the welfare state's most debilitating premise—that the sole provider for some of the most important goods and services must be the most inefficient institution in American life: the government. . .

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Is Congress Listening?

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8.         Innovations in Healthcare: How to become an Entrepreneur?

How to Get a Real Education – By SCOTT ADAMSWSJ

I understand why the top students in America study physics, chemistry, calculus and classic literature. The kids in this brainy group are the future professors, scientists, thinkers and engineers who will propel civilization forward. But why do we make B students sit through these same classes? That's like trying to train your cat to do your taxes—a waste of time and money. Wouldn't it make more sense to teach B students something useful, like entrepreneurship?

I speak from experience because I majored in entrepreneurship at Hartwick College in Oneonta, N.Y. Technically, my major was economics. But the unsung advantage of attending a small college is that you can mold your experience any way you want.

There was a small business on our campus called The Coffee House. It served beer and snacks, and featured live entertainment. It was managed by students, and it was a money-losing mess, subsidized by the college. I thought I could make a difference, so I applied for an opening as the so-called Minister of Finance. I landed the job, thanks to my impressive interviewing skills, my can-do attitude and the fact that everyone else in the solar system had more interesting plans.

The drinking age in those days was 18, and the entire compensation package for the managers of The Coffee House was free beer. That goes a long way toward explaining why the accounting system consisted of seven students trying to remember where all the money went. I thought we could do better. So I proposed to my accounting professor that for three course credits I would build and operate a proper accounting system for the business. And so I did. It was a great experience. Meanwhile, some of my peers were taking courses in art history so they'd be prepared to remember what art looked like just in case anyone asked.

One day the managers of The Coffee House had a meeting to discuss two topics. First, our Minister of Employment was recommending that we fire a bartender, who happened to be one of my best friends. Second, we needed to choose a leader for our group. On the first question, there was a general consensus that my friend lacked both the will and the potential to master the bartending arts. I reluctantly voted with the majority to fire him.

But when it came to discussing who should be our new leader, I pointed out that my friend—the soon-to-be-fired bartender—was tall, good-looking and so gifted at b.s. that he'd be the perfect leader. By the end of the meeting I had persuaded the group to fire the worst bartender that any of us had ever seen…and ask him if he would consider being our leader. My friend nailed the interview and became our Commissioner. He went on to do a terrific job. That was the year I learned everything I know about management.

At about the same time, this same friend, along with my roommate and me, hatched a plan to become the student managers of our dormitory and to get paid to do it. The idea involved replacing all of the professional staff, including the resident assistant, security guard and even the cleaning crew, with students who would be paid to do the work. We imagined forming a dorm government to manage elections for various jobs, set out penalties for misbehavior and generally take care of business. And we imagined that the three of us, being the visionaries for this scheme, would run the show.

We pitched our entrepreneurial idea to the dean and his staff. To our surprise, the dean said that if we could get a majority of next year's dorm residents to agree to our scheme, the college would back it.

It was a high hurdle, but a loophole made it easier to clear. We only needed a majority of students who said they planned to live in the dorm next year. And we had plenty of friends who were happy to plan just about anything so long as they could later change their minds. That's the year I learned that if there's a loophole, someone's going to drive a truck through it, and the people in the truck will get paid better than the people under it. . .

Why do we make B students sit through the same classes as their brainy peers? That's like trying to train your cat to do your taxes—a waste of time and money. Wouldn't it make sense to teach them something useful instead?

Healthcare needs more innovative Entrepreneurs.

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9.         The Health Plan for the USA: A graded copayment for every level of service

Level A: Hospital

The research from HPUSA has elucidated some important clinical statistics to control health care costs. This data is hard to obtain and cannot be automated. It is labor intensive. At this point it is clinical: one on one. When we see large expenditures in health care, we try to determine if the patient is a candidate to be included in our series. We then indulge in a frank discussion of his or her responses to the questions concerning percentage copayment and its effect on the patient’s utilization of health care benefits.

Health care can be stratified into a number of logical tiers. The most expensive and highly sophisticated care is in the traditional acute care hospital. We won’t get involved in any medical-political redefinitions of this level of care such as the somewhat controversial specialty hospital. We were even opposed to the spinning off of Psychiatric Wards to Psychiatric Hospitals several decades ago inasmuch as this lowered the level of care in these facilities for psychiatric patients.

The traditional hospital is like the mainframe computer industry of the third quarter of the twentieth century. Most of the mainframe companies didn’t adapt and are no longer in existence. IBM was the only one that was able to adapt and survive until the most highly sophisticated demands, such as accessing millions of ATMs simultaneously around the world on an integrated network that includes all financial institutions. IBM would not have survived if they had continued to compete in the laptop industry. When they sold their ThinkPad to Lenovo and refocused, they became the world leader in sophistication and problem solving again. We would expect them to develop Watson and compete with live human beings on Jeopardy.

Starting with the highest and most expensive strata of health care, the acute hospital, or the IBM of health care, what is the appropriate copayment for hospital work? The health care insurance companies have various forms of copayment, such as an 80/20 plan in which the patient pays 20 percent of the hospital charges and the insurance companies pay 80 percent. There are also 90/10 plans and those with fixed deductibles that bear no relationship to hospital charges.

There are two problems with these plans. First, few people can pay twenty percent of a $150,000 hospital bill. Even if it’s linked to a line of credit, the credit requirements are extraordinary.

Second, there is little transparency in hospital billing. Insurance companies have various arrangements with hospitals that the patient cannot see. In fact, hospitals have forced patients to go into hock for the 20 percent copayment (which is $30,000 in our example) and meanwhile the remaining $120,000 is discounted to the hospital, sometimes for even less than the patient is asked to pay on their 80 percent share. It may not be unusual for the hospital to take the patient to the cleaners for the $30,000 (20 percent) and accept the usual discounted hospital portion, which will be far less than the rest of the bill. We understand this has come under litigation and the results are not recalled.

With small or no deductible policies, it is not unusual for patients to show us statements indicating that their insurance company was billed $75,000 and the hospital accepted $7500 as payment in full. For co- payments to work effectively there has to be complete transparency. In other words, a patient knows up front what the hospital charges are and will be. This then allows for a percentage copayment to work effectively in controlling health care costs.

For instance, if a patient checks in for gallbladder surgery, he or she is told the usual charge for this procedure is, say, $20,000. And if your copayment is 10 percent, the patient is asked if he wants to write a check or utilize a credit card for the $2,000 copayment.

At this point in time, the patient can make a further assessment of the pros and cons for the surgery. A discussion with the spouse may remind him that his internist thought since he has had no gallbladder attacks, and his one stone was found on a routine exam for another problem, that he should forgo surgery for the present. In fact, they had agreed to wait, but the patient wanted to see a surgeon “for a second opinion.” Even though his internist advised against surgery, the surgeon was very convincing that he should have the operation. The internist had stated that if he hadn’t had the backache and the x-ray for that, they would not have known that he had a gallstone and the question would not have been raised. Now as they were staring health care costs in the face, they recalled this conversation. They had a number of other pressing financial struggles and so at the registration desk, he decided to put the credit card back in his billfold and sit tight for the present, realizing that an emergency could develop. However, his internist had advised him that given the nature of his stone, an emergency was not likely to occur.

Without going into the pros and cons of delaying any medical care, this simple maneuver has placed health care in the Medical MarketPlace and in competition with other finances. The Medical MarketPlace would have prevented the current catastrophic Medicare and Medicaid over utilization and our current health care crises. This further prevents utilization of our children’s finances, which obviously is very unethical. If this weren’t across generation lines, it would easily have been seen as Grand Theft because of the magnitude of the crime.

In our efforts to determine the best copayment that would control health care costs but not prevent necessary health care, we would sit down with the patient in a neutral time and make a determination: If you had a five percent copayment, would you have proceeded with the operation? If 7.5 percent? If 10 percent? If 15 percent? If 20 percent? If 25 percent? If 30 percent? Etc, et al.

Our results indicated that in the majority of cases, a 5 percent copayment did not control costs and allowed over utilization. A 15 percent or greater copayment controlled costs very well, but we felt it prevented some necessary hospitalizations or operations. For the vast majority of patients, a 10 percent copayment controlled over utilization of hospital care rather well but did not prevent necessary health care that would reduce the quality of care.

Hence, in our research so far, a ten percent copayment on hospitalizations was the ideal amount to prevent over utilization and not cause under utilization.

If the health care insurance is further tied to a line of credit at a favorable interest rate appropriate for sick people, that could be administrated by one of the credit card companies, everyone would have access to the highest level of health care.

To read about Level B etc, stay tuned.

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

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

· Entrepreneur-Country. Julie Meyer, CEO of Ariadne Capital, (Sorry about the nepotism, but her message is important) recently launched Entrepreneur Country. Read their manifesto for information:  3. The bigger the State grows, the weaker the people become - big government creates dependency . . .  5. No real, sustainable wealth creation through entrepreneurship ever owed its success to government . . .  11. The triple play of the internet, entrepreneurship, and individual capitalism is an unstoppable force around the world, and that Individual Capitalism is the force that will shape the 21st Century . . .  Read the entire  manifesto . . .

· Americans for Tax Reform,, Grover Norquist, President, keeps us apprised of the Cost of Government Day® Report, Calendar Year 2010. 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 2009 was August 12, a seven-day increase above last year's revised date of August 19. With August 19 as the COGD, working people must toil on average 231 days out of the year just to meet all the costs imposed by government. In other words, the cost of government consumes 63 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 80 percent or nearly three-fourths of our productivity and destroy our health care in the process. We would have almost no discretionary income.

· National Taxpayer's Union,, Duane Parde, President, 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 On August 20 last year, you started working for yourself. It takes nearly 8 months of hard work for every American to pay for the cost of government. Read more  . . .

· Evolving Excellence—Lean Enterprise Leadership. Kevin Meyer, CEO of Superfactory, (Sorry about the nepotism, but his message is important) has started a newsletter that impacts health care in many aspects. Join his evolving excellence blog . . .  Excellence is every physician’s middle name and thus a natural affiliation for all of us.  This month read his Blog at A recent blog no long on site was The Customer is the Boss at FAVI “I came in the day after I became CEO, and gathered the people. I told them tomorrow when you come to work, you do not work for me or for a boss. You work for your customer. I don’t pay you. They do. . . . You do what is needed for the customer.” And with that single stroke, he eliminated the central control: personnel, product development, purchasing…all gone. Looks like something we should import into our hospitals. I believe every RN, given the opportunity, could manage her ward of patients or customers in similar lean and efficient fashion.

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

· Ayn Rand, a Philosophy for Living on Earth,, is a veritable storehouse of common sense economics to help us live on earth. To review the current series of Op-Ed articles, some of which you and I may disagree on, go to 

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Del Meyer, MD, CEO & Founder

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

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Always remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people’s welfare.

Thus we must also remember that ObamaCare has nothing to do with appropriate healthcare; it was projected to gain loyalty by making citizens depended on the government and eliminating their choice and chance in improving their welfare or healthcare.

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