|
HEALTHPLANUSA . NET |
QUARTERLY NEWSLETTER |
|
Community
For Affordable Health Care |
Vol
V, No 4, January, 2007 |
To Transform the $1.8 Trillion HealthCare Industry
into Affordable HealthCare
1. Featured Article: SelfCare
- Essentials of 21st Century Health Care Reform
2. In the News: Fast
Food Arby’s CEO Runs MinuteClinic
3. International
Medicine: Reforming
the State Healthcare Monopoly
4. Medicare: Hospital Stays Can Be Decreased by Increasing
Co-Payments
5. Lean HealthCare:
The True Origins of Lean Health Care – Permanente
6. Medical Myths: Air
Pollution is Increasing Asthma
7. Overheard on
Capital Hill: Environmental Confusion
in Congress
8. What’s New in US Health Care: Capitalism Prescription
9. Health Plan USA: Focus
on the Private System – Between Medicaid and Medicare
*
* * * *
1. Feature
Article: SelfCare - Essentials of 21st
Century Health Care Reform
Proposals to healthcare reform
should be judged not on the goodness of their intentions but rather on the
basis of their results – in other words: nobody washes a hired car by Dr Fred Hansen
[Insights from the UK and their NHS for the world
health care outlook.]
The focus on consumer choice within both major
parties seems to respond to the core weakness of the British health system, as
reported by patients (A Coulter, Picker Institute BMJ: 331, 19/11/05, pp 1199).
The deplorable heritage of the NHS - its cold war bureaucracy and a
paternalistic doctor-patient relationship – is the very opposite of choice. And
there are many doubts whether the recently introduced patient choice between
hospitals for elective surgery is the most urgent kind of choice that people
are coveting. Over 500 consultants of Doctors for Reform have declared: “The
NHS was conceived more than half a century ago, at a time of rationing and
considerable poverty. We once believed it was the finest healthcare system in
the world. Today few healthcare professionals would make that claim.” Indeed
Britain seems to be coping worse than other Western countries with soaring
health costs and is dramatically falling behind other Western countries in such
crucial things as cancer survival rates.
The intangible revolution
Quite a different issue is to predict the future of the NHS in a competitive
global health market. As everybody knows, here are economies of scale,
particularly in purely knowledge-based goods. This is what some experts like
Roger Boothe call the intangible revolution. They maintain that the economic
potential and wealth creation of the knowledge-based technology of the future
is enormous. This is especially true for the health sector which in the future
will produce lots of intangible products and services. But today, as a closed
market, the NHS simply cannot compete with the lower prices of the much larger
international markets. That’s the bad news. The good news is that the globalization
of healthcare services and products is the best way to contain exploding costs
everywhere. Surprisingly loss of control over health expenditures happens in
very many countries, regardless of ideology and the way health care is
organized – from central Europe to the United States of America.
Control over health expenditure
is the main challenge
Some countries have already responded to exploding
costs with incentives to save money at the origin of all health expenditures:
the patient or consumer. These ideas try to encourage more responsibility by
healthcare users. . .
Public confidence in health
reform is dwindling
Unfortunately nothing like this is happening in
Britain, except in some private insurance companies. Not surprisingly, 54% of
electors don’t believe that the billions of pounds that Labor has been pouring
into the NHS since 2000 will result in real improvements, and only 39% agree
that it will do so. . . In a recent MORI poll 44% of people said they expect
the NHS is getting worse, only 22% held the opposite opinion. Other surveys
have suggested that the American managed care organization Kaiser Permanente
was much more cost effective than the NHS run programs (BMJ 24 August 2004).
The crucial difference between both was that Kaiser employed many more
consultants per patient than the NHS.
Social and medical Progress
The NHS was founded in times when political and
social collectivism prevailed – as were the dominant concepts of epidemic and
contagious diseases. And this is reflected not only in the health bureaucracies
created by Aneurin Bevan but even today in the top-down centralism of the NHS.
But social and medical progress renders those collectivist concepts obsolete. .
.
Dramatic change of disease burden
Past social progress and ongoing medical
innovation have led to a fundamental transformation in the disease burden, due
to changes in two major areas.
Firstly the affluent Western societies created a
lifestyle which is outright unhealthy. It is to blame for the leading causes of
death these days: coronary heart diseases, stroke, many different cancers,
sexually transmitted diseases, asthma, diabetes and fatalities of
poly-pharmacy. This lifestyle encompasses smoking, overeating, promiscuity with
unprotected sex, abuse of illicit drugs like cocaine and alcohol and lack of
exercise. In response, we consume vast amounts of medicines in the attempt to
postpone or avoid any deterioration of health. Prudent disease prevention and
health improvement through healthy lifestyles are the exception.
Secondly, globalization with mass tourism and mass
immigration has introduced or brought back a host of infectious and tropical
diseases to the Western societies. These include the reemergence of
tuberculosis as a corollary of the HIV epidemic, diphtheria and other
infectious diseases. International sex tourism also has given a booster to
sexually transmitted diseases. All these factors and the masses of new
immigrants with no or poor English language skills have put our Western health
systems, not at least the free-for-all English NHS, under considerable
pressure.
Not surprisingly, according to a survey by the
think tank Reform, the productivity of the NHS has constantly declined over the
last decades despite a huge increase of the NHS budget.
Since unhealthy lifestyles are to blame for much
of the Western disease burden, this is where we need to look first in terms of
keeping healthcare costs under control. Simple exhortation is not enough, as we
have seen on the obesity epidemic for example.
So how can we achieve sustainable ways of behavior
or lifestyle changes?
Setting the right incentives for
consumer choice
The most promising solution would be to give
patients/consumers back responsibility for their own health, and control over
their own health care expenditures. Only thus we can contain the progress of
chronic diseases driven by lifestyles in which peoples damage their own health.
The clue is self-reliance and incentives for people to look after their own
health, supported by full access to health information via the web and a viable
health insurance system. Previous attempts to get people to live healthier have
failed because they lacked any economic underpinning or incentives to do the
right thing. But at least they may have raised awareness of the problem.
Patients value self-care high
According to surveys (Picker Institute, Oxford)
most patients value preventive advice and support for self-care high. But our
healthcare system does not offer any reward or incentive for combined efforts
of doctors and patients to achieve this. . .
Health care funding needs to be
linked to personal risks and lifestyle
Abandoning third-party payment systems is the
truly global solution to the health care crisis. It is the way to make health
care systems sustainable over the generations. It clearly implies a turn to
individualized methods of raising health care funds: only this allows different
patterns of individual health risks to be taken into account. It implies a
competitive insurance system of staggered premiums according to different
risks. Only then we might accomplish a fully patient/consumer-driven health
care.
Provision of health care by
private companies is not enough
The tax-funded system of health care in this country
has become counterproductive. It does not give any incentive to prevent or
avoid diseases. As a result not only should the provision of health care be
decentralized, but also opened up to market forces, as initiated by the Tories
and continued by New Labor.
However, if only the delivery of health care is
privatized there remains the problem of collective or state purchasing of
health services. Any kind of third party commissioning as a proxy for patients
is prone to bureaucratic failures and complexity. Probably the most advanced
concept, although not implemented yet, has been developed by Newt Gingrich at
the Washington based Center for Health Transformation (CHT). He is attempting
to abolish third-party payments in all US public healthcare provision under
Medicaid and Medicare.
This means that the patient acquires full consumer
power since he is put in control of all health expenditures on his behalf. The
crucial point of a consumer-driven healthcare system will be the direct link
between personal lifestyle and individual control of health expenditure with
fully informed consumers. . .
Markets can best address
inequalities in health
Contrary to the prevailing prejudice, healthcare
is not much different than other sectors where the market prevails. True, the
bulk of our healthcare resources are taken up only in the last couple of years
before we die. . .
Evidence that the new concept
will work
Evidence that a combination of activity, attitude,
and good nutrition, can actually achieve a significant improvement in health
and can prevent or at least postpone chronic diseases was provided by
scientists at Nestlé - most of all in the area of obesity and diabetes. They
have also proven that the improvement of physical health will make a huge
difference in figures of mental health - showing that there is a strong
connection between both. It is not at all surprising that lifestyle changes
like increased physical activity and weight loss will also decrease depression
and anxiety. Without treatment depression and anxiety can result in
unemployment, unnecessary disability, substance abuse, inappropriate
incarceration, suicide and homelessness.
The challenges for self care
The self monitoring of health parameters and
introduction of personal risk management will be big challenges, but well worth
it. Special bespoke software programs for consumer health control solutions
need to be developed in the near future. If instead of just one third of the
British population being able to maintain a normal body weight, two-thirds
could do so, then the disease burden or work load for the health service could
be nearly halved.
Contrary to the common belief free access to the
health service without payment does not serve the patient because it is an
invitation to neglect your health and leads to a general waste of resources.
One example for this is that, according to a recent survey (Picker-Institute,
Oxford) British patients, used to the NHS, are less inclined to get involved in
health improvement than patients in almost all other European countries.
Another example is the millions of missed appointments with consultants, GPs
and nurses in the NHS.
Public health is to be
reconsidered
Fifty years of Public Health in the NHS have
witnessed a complete failure to improve the health of the population at large.
Apart from vaccinations in childhood and cancer screening, which are more or
less established in all Western countries and not a merit of NHS-style public
health, most other public health interventions to target things like cholesterol,
weight and blood pressure have failed. There is poor evidence that this kind of
public health interventions achieve any long-term health improvements.
Admittedly, in other Western countries the results are not any better. It is
therefore as true for state health interventions as for other things: market
forces tend to be the stronger. . .
Doctors for Reform
Recently Doctors for Reform rejected the current
tax-based healthcare system in Britain. As Dr Christopher Lees, one of the
founders admitted the group was disappointed by the Wanless Report’s conclusion
that taxation was the best way to fund healthcare. Doctors for Reform are
looking increasingly to health care systems in continental Europe, one of the
favorite candidates being Switzerland which has implemented the most advanced
market based health-reform - it combines mandatory social insurance with
individual discounts for people who stick to a healthy lifestyle and take up
less health care resources. In the Swiss system employers no longer contribute
to health insurance for their employees.
. . . “The NHS as we know it has had its day”,
said the founder of the group, the oncologist Professor Karol Sikora. He added,
tax finance is simply no longer fair because people with a healthy lifestyle
have to subsidize people, who knowingly damage their health in a variety of
ways. Indeed the NHS provides incentives not to bother about one’s health and
even to remain ill in order to get the most out of the NHS. It is another
example of the welfare state that actually encourages people to the opposite of
what it seeks to achieve. James Bartholomew has looked into this in his book “The
Welfare State we are in”. . .
Implementation
How can we implement this new concept of consumer
driven health care?
To read the answer as well as the entire original
article, go to www.adamsmith.org/health/index.php/health/think_piece/selfcare/.
*
* * * *
2. In the News: Fast Food Arby’s CEO Runs MinuteClinic, Fast Company
Welcome to drive-thru health care: It’s
conveniently located inside your local Target, CVS pharmacy, or supermarket;
it’s quick, cheap, and stays open late and on weekends. Physician assistants or
nurse practitioners (not doctors) will diagnose, and prescribe drugs for, the
dozen most common ailments—your ear infections, your allergies, etc.—for
between $28 and $110 (about half of what you’d pay at a doctor’s office and a
fraction of the cost of an ER visit). And no appointment is necessary.
When MinuteClinic hired CEO Michael C. Howe
last June, the five-year-old company had 22 locations in
Howe, a former CEO of Arby’s, predicts that his
short-order approach will transform the healing arts. He says his run as a
sandwich mogul gave him “an appreciation of the importance of the customer, or
in this case, the patient.” If it gives you pause to have a roast-beef
professional overseeing little Suzy’s lab results, know that after 360,000
patient visits, MinuteClinic reports a 99% satisfaction rate. And Dr. Stephen
Schoenbaum, executive vice president for programs at the Commonwealth Fund, a
nonpartisan health-care grant-making and research tank, gives the clinics a
qualified thumbs-up: “My one concern would be continuity” of care, he says. But
“our health-care system at the moment is so fragmented that [continuity] is
only a small component in a very large problem.” --Anya Kamenetz
www.fastcompany.com/magazine/103/open_46-howe.html
* * * * *
3. International Medicine:
Reforming the State Healthcare
Monopoly by Dr Eamonn Butler
Despite the billions poured into Britain’s state-run healthcare system,
people still face long waits and complain of unresponsive service. But that is no
surprise in such a centralized tax-funded monopoly. Its sheer size makes it
impossible to manage, while its politicization makes it impossible to reform.
Instead, we should follow the lead of almost every other country, and shift
the balance of healthcare spending away from tax and more to the individual.
There are many examples of social-insurance systems, tax credits, and direct
payment plans that give healthcare users real customer power over the
providers, while still ensuring that everyone has full access to the care they
need.
At the same time, we need to transform today’s state monopoly providers
into independent, competitive ones – giving them the incentive to drive
improvement and ensure that users are fully satisfied with the service they
receive.
To read the whole story, please go to www.adamsmith.org/health/index.php.
Dr Eamonn Butler is
director of the Adam Smith Institute, an influential think-tank which for more
than twenty years has designed and promoted practical policies to promote
choice and competition in the delivery of essential services. Independent and
non-partisan, the Institute was at the intellectual leading edge of the
Having graduated from the
To read more of Dr.
Butler’s biography, go to www.adamsmith.org/contact/butlerbio.htm.
Medicare
does not give timely access to healthcare, it only gives access to a waiting
list.
--Canada’s Supreme Court
* * * * *
4. Medicare: Hospital Stays Can Be Decreased By Increasing
Co-Payments
The largest-ever study on
the effects of health care co-payment costs on emergency department visits has
revealed that requiring patients to pay for a portion of the cost can reduce
the number of visits. The study also finds that this decrease does not
negatively affect health.
”The results of this study are encouraging in that these modest co-payments
appeared to reduce health care use, and therefore overall costs, without harming
patients,” says Dr. John Hsu, lead author of the study.
While emergency visit rates decrease substantially as the co-payment increases,
the findings show no increase in the rate of unfavorable clinical events
(hospitalization, intensive care admission) and no increase in deaths.
The population-based
experiment followed over two million commercially insured and 250,000 Medicare
insured patients.
This study is published in the October issue of Health Services Research.
The federal government did
the same type of study prior to offering Medicare. That study showed that a
co-pay as low as $5 cut demand for medical care by 50%. Then the Leftists
forced Supplemental Insurance to come about to alleviate the patient paying the
co-pay.
Funny how it is continually
necessary to prove the world is not flat.
–Bob, a MedicalTuesday Member.
Dr. Hsu is an internist and
health services researcher in the Kaiser Permanente Division of Research and a
fellow at the Institute for Health Policy. Dr. Hsu is the principal investigator
on two AHRQ and NIH sponsored studies on patient cost-sharing.
Health Services Research (HSR) provides those engaged in research, public
policy formulation, and health services management with the latest findings,
methods and thinking on important policy and practice issues. Providing a forum
for the expansion of knowledge of the financing, organization, delivery and
outcomes of health services, HSR also allows practitioners and students alike
to exchange ideas that will help to improve the health of individuals and
communities. HSR is published on behalf of Health Research and Educational
Trust in cooperation with AcademyHealth. For more information, please visit: www.blackwell-synergy.com/loi/hesr.
Government is not the solution
to our problems, government is the problem.
- Ronald Reagan
* * * * *
5. Lean HealthCare: The
True Origins of Lean Health Care - Permanente
Dr Garfield’s Enduring Legacy—Challenges
and Opportunities, Jay Crosson, MD
It’s about time. For too long, Sidney
Garfield, MD, has stood in the giant shadow cast by his more celebrated partner
and friend, Henry J Kaiser, the great entrepreneur and industrialist. Mr
Kaiser’s name and fame live on, mainly in association with the only nonprofit
organization ever incorporated by the builder of more than 100 for-profit
companies—Kaiser Permanente (KP). But the physician whose extraordinary vision
and daring innovations in health care delivery that gave birth to that same
organization remains largely unrecognized beyond the select circle of medical
historians and the heritage-minded physicians and staff of KP.
One needn’t minimize the vital role of Mr
Kaiser in KP’s story to assert the seminal role played by Dr Garfield. They
were genuine partners, each bringing to the enterprise critical elements
lacking in the other: money and organizational genius from Mr Kaiser; a
visionary mind and an unrelenting drive for innovation and quality improvement
from Dr Garfield; and from both a genuine belief in and commitment to human
dignity and progress.
This centennial of Dr Garfield’s birth is a
timely occasion not only to recall and celebrate his role in creating and
evolving the unique model of health care delivery that would become KP, but to
examine as well some of his key insights and innovations with regard to the
current and future state of American health care. Fortunately, Dr Garfield
himself articulated his ideas in a number of influential documents. These
included, most importantly, his 1945 address to the Multnomah County Medical
Association in Oregon, in which he spelled out the essential elements of what
we have come to call Permanente Medicine, and a forward-looking article in the
April 1970 issue of Scientific American2 (see page 46). In
that article, he reiterated those foundational qualities and went on to
anticipate a radical transformation of the health care system via the incipient
power of information technology. In addition, the evolution of his ideas was
expertly traced and recorded by his physician colleague John Smillie, MD, in
his excellent 1991 history of KP, Can Physicians Manage the Quality and Cost
of Health Care?
Anyone who has examined Dr Garfield’s long
career will appreciate the difficulty of assessing the historical and/or
current relevance of his ideas and innovations. As his diminishing number of
surviving colleagues will attest, he was a fount of ideas—virtual intellectual
fireworks—admittedly igniting a few duds among the brilliant rockets. The ideas
ranged across the entire spectrum of health care, from delivery models to
financing to hospital design. In the end, it may fairly be said that he
achieved his childhood dream of becoming an engineer (he is said to have broken
down and cried when his parents insisted he attend medical school) by
engineering our unique model of health care.
But among all his many lasting contributions,
which ones constitute the essential core of his life’s work? And what relevance
do they have for today and tomorrow?
I believe Dr Garfield’s lasting reputation
will rest on four big ideas that, individually and in combination, powered
fundamental transformations in health care. They are:
·
the change from
fee-for-service to prepayment
·
the promotion of
multispecialty group practice in combination with prepayment
·
the emphasis on
prevention and early detection to accomplish what he termed “the new economy of
medicine,” in which providers would be rewarded for keeping people healthy;
and,
·
finally—and most
presciently—the centrality of information technology in the future of health
care.
Significantly, each one of these 20th
century innovations, three of which are deeply embedded in KP’s own genetic
code, is at or near a critical crossroads in this first decade of the 21st
century, either still struggling for broad acceptance or under fresh assault as
failed assumptions. Let us briefly examine each in turn.
To examine these four fundamental principles,
please go to http://xnet.kp.org/permanentejournal/summer06/legacy.html.
Most important, the
principles themselves are not the object of Permanente Medicine. If there are
better ways to achieve the ends of Permanente Medicine—defined by Dr Garfield
himself as “to provide the best quality care our members can afford”—we should
never be shy about making corrections, adjustments, refinements, or wholesale
changes when demanded by our own 21st century environment. Permanente
Medicine—Dr Garfield’s great gift to American medicine—will endure only so long
as it remains a living, growing, adapting way of practicing medicine.
To read more about the centennial of Dr.
Sidney R Garfield’s birth, the Founder of Permanente, and his partnership with
Henry J Kaiser, please go to http://xnet.kp.org/permanentejournal/summer06/featureTOC.html.
To read Dr. Garfield’s seminal article in Scientific
American in 1970, click on The Delivery of Medical Care at the above URL.
* * * * *
6. Medical Myths:
Increasing Air Pollution is Increasing Asthma.
Facts Not Fear on Air
Pollution by Joel Schwartz, www.ncpa.org/pub/st/st294/
Executive Summary:
Air pollution has been
declining for decades across the
·
Fine particulate matter
(PM2.5) declined 40 percent.
·
Peak 8-hour ozone (O3) levels declined 20 percent, and days
per year exceeding the 8-hour ozone standard fell 79 percent.
·
Nitrogen dioxide (NO2) levels decreased 37 percent, sulfur
dioxide (SO2) dropped 63
percent and carbon monoxide (CO) concentrations were reduced by 74 percent.
·
Lead dropped 96 percent.
What makes these air
quality improvements so extraordinary is that they occurred during a period of
increasing motor vehicle use, energy production and economic growth. Between
1980 and 2005:
·
Automobile miles driven
each year nearly doubled (93 percent) and diesel truck miles more than doubled
(112 percent);
·
Tons of coal burned for
electricity production increased about 61 percent; and
·
The real dollar value of
goods and services (gross domestic product or GDP) more than doubled (114
percent).
Air pollution of all kinds
declined sharply because of cleaner motor vehicles, power plants, factories,
home appliances and consumer products.
Not only are Americans
unaware that air quality has improved, they also harbor fears about air
pollution that are out of proportion to the minor health risks posed by today’s
historically low air pollution levels:
·
The prevalence of asthma
rose 75 percent from 1980 to 1996, and nearly doubled for children; however,
air pollution cannot be the cause, since it declined at the same time asthma
increased.
·
Emergency room visits
and hospitalizations for asthma are lowest during July and August, when ozone
levels are highest.
·
Reducing nationwide
ozone from 2002 levels (by far the highest levels of the last six years) to the
federal 8-hour ozone standard would reduce respiratory hospital admissions by
0.07 percent and asthma emergency room visits by only 0.04 percent, according
to the Environmental Protection Agency (EPA) and California Air Resources Board
(CARB).
Regulators, scientists and
journalists have all played a role in perpetuating baseless fears. For
example:
·
Studies that report harm
from air pollution are more likely to be published and receive press coverage
than studies that do not.
·
Government officials
fund much of the research, and the funding is provided with the explicit intent
to provide proof of harm from air pollution.
·
Regulators create fear
through regional air pollution alert systems, such as “code red” days; even
though pollution levels are dropping, the number of warnings increases because
of increasingly tighter standards.
This constant stream of
alarmist studies and air pollution warnings maintains unwarranted anxiety that
air pollution is causing great harm. Furthermore, omission of contrary
evidence on air pollution and health is common among researchers, journalists,
activists and regulators, causing claims of harm from air pollution to appear
more consistent and robust than suggested by the actual weight of the
scientific evidence.
None of this would matter
if air pollution could be reduced for free. But reducing air pollution is
costly. Attaining the federal standards will cost tens to hundreds of
billions of dollars per year. These costs are ultimately paid by people
in the form of higher prices, lower wages and reduced choices.
Some requirements are
especially counterproductive. For example, New Source Review (NSR)
requires businesses to install “state-of-the-art” pollution controls to achieve
the lowest possible emission rates when they build new plants. This gives
businesses an incentive to keep older, less-efficient and higher-polluting
plants operating well beyond their useful lives, rather than build
less-polluting new plants. NSR harms consumers by slowing the pace of
pollution reductions, raising the cost of any pollution reductions that do
occur, and increasing the prices of consumer goods by slowing innovation and
reducing competition.
Perhaps the most harmful
aspect of the air quality regulation is that it has no negative feedbacks that
would slow down or stop its bureaucratic expansion. Regulators’ jobs and
powers depend on a public perception that air pollution is a serious and urgent
problem. But regulators also fund much of the research intended to
demonstrate the need for more regulation, and fund environmental groups to
agitate for increases in regulators’ powers. Regulators also set the
level of the health standards, meaning that they get to decide when their job is
finished. Naturally, it never will be. And as the standards are
tightened, the number of daily air pollution “alerts” increases, even as actual
air pollution levels continue to decline.
The bureaucratic incentives
built into air quality regulation explain why regulators and activists work so
hard to make it appear that air pollution is still a serious problem, even as
air pollution has reached historic lows that have, at worst, minor effects on
people’s health.
Air pollution affects far
fewer people, far less often and with far less severity than regulators,
environmentalists, health scientists and journalists have led Americans to
believe. By pursuing tiny or nonexistent health benefits at great cost,
air pollution regulations are making us worse off.
To read the details of the
story, please click below or go directly to www.ncpa.org/pub/st/st294/.
* * * * *
7. Overheard
on Capital Hill: Environmental
Confusion in Congress
Deming
to Congress: Public Misinformed
There is an overwhelming bias
in the media regarding the issue of global warming, NCPA E-Team Adjunct Scholar
and
Deming told Senators that a reporter for National Public Radio once
offered to interview him about one of his climate studies, “but only if I would
state that warming was due to human activity. When I refused, he hung up.”
Air pollution is not a growing problem or a
serious threat to public health, according to a new NCPA study. “The truth is,
air quality in
“Americans harbor health fears
about air pollution that are far out of proportion to the minor risks posed.”
The study is based on his book, “Air
Quality in
www.ncpa.org/pub/speech/2006/20061206-sp.html
Federal wetlands
regulations and the Superfund program will be top priorities for the
Environment and Public Works Committee, said incoming chair, Sen. Barbara Boxer
(D-CA). Boxer advanced a broad
environmental legislative agenda, including reducing farm runoff pollution and
improving drinking water. She also
promised to hold a field hearing to discuss environmental problems remaining
from Hurricane Katrina.
Meanwhile, Sen. Larry Craig
(R-ID) thinks that a Democrat-controlled Congress will not be able to pass
legislation that limits emissions of greenhouse gases. Sen. Craig said that not
only could Sen. Boxer’s legislative agenda not withstand filibuster, he doesn’t
think incoming House Energy and Commerce Committee Chairman John Dingell (R-MI)
will support her agenda. “Climate
change is an idea of the past,” Craig said. “There isn’t a nation in the world
that ratified
We should cut off all funding of our prejudicial
public radio system with taxpayer funds.
* * * * *
8. What’s
New in US Health Care: For Health Care Woes, a Capitalism Prescription By David Gratzer, Special to washingtonpost.com's Think Tank
Town,
Amid the Congressional page scandal, the most
important pocketbook issue of the election is getting lost in the noise of the
campaign season. Health care costs are not just soaring, they're reaching
unaffordable levels, meaning that we'll have to look to managed care (again) or
find a government solution, a prescription for rationing. With spiraling costs
projected to continue, thereby doubling spending in the next 8 years, that
choice will be made by 2014 unless we find a third option. What's the cure?
Congress needs to administer a strong dose of capitalism.
Businesses struggle to pay for health premiums, which have
nearly doubled since 2000. It's not simply corporate giants like GM that have
trouble -- only 61% of American companies offer their employees health
insurance, down from 69% in 2000. Even insured Americans feel the pinch --
though labor costs are up, median family income has dropped 2.6% over the past
half decade, the largest decline since the last recession, in large part
because soaring health premiums have swallowed up new money.
The situation will precipitously worsen in the next
seven years as health spending is projected to rise to $4 trillion dollars a
year, up from $2 trillion. Former Health and Human Services Secretary Tommy
Thompson declares this unsustainable, noting that as a percentage of
But for employers, employees, and government officials
already fretting the cost of health care, beware: you haven't seen anything
yet.
For years, the debate has been about 2 options for
dealing with the cost crunch.
First, embrace HMOs. The idea faltered in the late
1990s but managed care held costs relatively stable in the mid-1990s (rising,
for example, just 2 percent in 1996). But HMOs turn basic decisions over to
bureaucrats, a paternalistic philosophy at odds with American values.
Second, convert to some type of government health
care, an approach every other Western country has adopted. Though the idea
grows in popularity --
Is there another option? Look to capitalism, which
governs the other five-sixth of the economy. Ultimately, we must choose market
reforms.
That may sound easy enough, but for more than 60
years, government policy has drifted fitfully in the opposite direction. In the
rest of the economy, we have moved away from regulations, price controls, and
overreaching government agencies. Yet in health care, we have distorted the tax
code, bulked up the Medicaid rolls, and let a million regulations bloom.
Medicare alone has more than 100,000 pages of them. Price controls are endemic
to Medicare and Medicaid. The result is a half-broken, semi-socialist system,
low in satisfaction and high in cost.
How to employ market reforms? Here are five simple
steps. . . To read these and the rest of the article, please go to www.washingtonpost.com/wp-dyn/content/article/2006/10/24/AR2006102401002_pf.html.
David Gratzer,
a physician, is a senior fellow at the Manhattan Institute for Policy Research.
He is the author of The Cure: How Capitalism Can Save American Health Care
(Encounter Books).
*
* * * *
9. Health Plan
As
our focus group reviews the health systems of the world and compares them with
the current
Dr. Brian Day, the
President-Elect, is not simply a critic of
Dr. Day, in some ways, is an
unusual messenger. He grew up in a socialist home in
We
have many physicians who are increasingly supporting a government-run system.
It is important to maintain a dialogue with our colleagues so we don’t have to
go through the unfortunate learning process that physicians in
The
answer to our country’s health care challenges will reside primarily in the
private or free-market sphere. We’ve presented a number of articles in this
quarterly report which shows global vital activity and thinking about these
issues. We appreciate the responses we have received. If yours has not been
acknowledged, be sure that we read all of them and respond and incorporate your
responses and suggestions as time permits.
* * * * *
10. Restoring Accountability in Medical
Practice by Non Participation in Government Programs and
Understanding the Devastating Force of Government.
·
Grover Norquist,
President of Americans for Tax Reform,
www.atr.org/ keeps us apprised of the Cost
of Government Day® Report, Calendar Year 2006 Fourteenth Edition, www.atr.org/content/pdf/2006/July/071206ot-costofgovernmentday.pdf.
Cost of Government Day (COGD) is the date of the calendar year on which the
average American worker has earned enough gross income to pay off his or her
share of spending and regulatory burdens imposed by government on the federal,
state and local levels. Cost of Government Day for 2006 is July 12th,
a one day increase above last year’s revised date of July 11th. With
July 12th as the COGD, working people must toil on average 192.5
days out of the year just to meet all the costs imposed by government. In other
words, the cost of government consumes 52.7 percent of national income. If we
were to put health care into the public trough, the additional 18 percent would
allow the government to control 70 percent or nearly three-fourths of our
productivity and destroy our health care in the process. We would have almost
no discretionary income. Be sure to listen to Leave Us Alone! with Grover
Norquist at www.atr.org/special/misc/leaveusalone/index.html.
·
John Berthaud,
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
·
The Adam Smith
Institute, Eamonn Butler, Director, www.adamsmith.org/health/index.php,
Extending
access to quality healthcare through diversity and competition. To read about
funding UK Health Care, go to www.adamsmith.org/health/index.php/publications/details/funding_uk_healthcare/.
·
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 very insightful Op-Ed articles, go to www.aynrand.org/site/PageServer?pagename=media_opeds.
There will be something for everyone.
·
John and Alieta Eck, MDs, for their first-century solution to twenty-first
century needs. With 46 million people in this country uninsured, we need an
innovative solution apart from the place of employment and apart from the
government. To read the rest of the story, go to www.zhcenter.org. Stay tuned for
their next innovative move in designing the healthcare system for the entire
country of
·
Michael J. Harris, MD - www.northernurology.com - an
active member in the American Urological Association, Association of American Physicians
and Surgeons, Societe’ Internationale D’Urologie, has an active cash’n carry
practice in urology in
·
PRIVATE
NEUROLOGY is a Third-Party-Free
Practice in
·
PATMOS EmergiClinic - where Robert Berry, MD,
an emergency physician and internist states: “Our point-of-care payment clinic
makes acute and chronic primary medical care affordable to the uninsured of our
community by refusing to accept any insurance (along with the hassles and
crushing overhead that inevitably come with it). Read the rest of the story at www.emergiclinic.com.
* * * * *
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 largely
attributable quotes in the interest of the health care debate. Editorial
comments are in brackets.
ALSO
NOTE: MedicalTuesday and HPUSA receive 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.
* * * * *
Academics and their arrogance held that gifted elite academics could
organize and run society so much better on their scientific socialist model,
than the pitiful stupid ignorant masses were currently able to accomplish on
their own. William Buckley’s classic response was that he would rather be
governed by the first 2,000 names in the
The world is governed more by
appearances than by realities, so that it is fully as necessary to seem to know
something as it is to know it. —Daniel
Webster
An appeaser is one who feeds
a crocodile—hoping it will eat him last.
–Sir Winston Churchill
“How can I ever show my
appreciation?” asked a patient who had just recovered from a serious illness.
“My dear woman,” replied the physician, “ever since the Phoenicians invented
money there has been only one answer to that question.” –Medical Folklore
To understand why physicians are almost persuaded to join the bandwagon
of Socialized Medicine, read the background about how they were once previously
almost persuaded but came to their senses before it was too late. www.delmeyer.net/bkrev_AlmostPersuaded.htm
Alexander Solzhenitsyn asks,
“What do you mean by 'free’? Universal and public—yes. Free, no. The doctors
don’t work without pay. It’s just that the patient doesn’t pay them. They’re
paid out of the public budget. The public budget comes from these same
patients. Treatment isn’t free, it’s just depersonalized.” www.healthcarecom.net/bkrev_CancerWard.htm
Read last quarter’s HPUSA issue at www.healthplanusa.net/October06.htm.
Find the entire archives of HPUSA at www.healthplanusa.net/NewsLetterIntro.htm.
This Year in The Future
Peter Drucker’s Message for the New Year: Integrity in Leadership
The proof of the sincerity and seriousness of a management is
uncompromising emphasis on integrity of character. For it is character through which
leadership is exercised; it is character that sets the example and is imitated.
Character is not something one can fool people about. The people with whom a
person works, and especially subordinates, know in a few weeks whether he or
she has integrity or not. They may forgive a person for a great deal:
incompetence, ignorance, insecurity, or bad manners. But they will not forgive
a lack of integrity in that person. Nor will they forgive higher management for
choosing him.
We wish each and every one of
you and yours
A HAPPY NEW YEAR
And Freedom in Health Care to
Make it Affordable to All