|
HEALTHPLANUSA . NET |
QUARTERLY
NEWSLETTER |
|
Community For Affordable Health Care |
Vol VII |
Utilizing the
$1.8 Trillion Information Technology Industry
To
Transform the $2.4 Trillion HealthCare Industry into Affordable HealthCare
In This Issue:
1. Featured Article:
The Patient Safety Crusade--a
Phony Crisis
2. In the News:
Obama’s Budget Director Orszag's Health Warning
3. International
Medicine: A Foretaste of the Future of American Medicine?
4. Medicare:
Obama’s Health Plan Is A Federal HMO according
to Sally Pipes
5. Lean HealthCare: Hospital Stays Can Be
Decreased By Increasing Co-Payments
6. Misdirection in
HealthcareMedical Myths:
98,000 people die from
medical errors each year
7. Overheard on
Capital Hill: The President Reads A Book A
Week
8. What's New in US
Health Care: Creating Lean Healthcare,
by Jim Womack
9. Health Plan USA:
Developing the Ideal
HealthPlan for the USA
The
Annual World Health Care Congress,
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 3rd
annual conference was held April 17-19, 2006, in Washington, D.C. One of the
regular attendees told me that the first Congress was approximately 90 percent
pro-government medicine. The third year it was 50 percent, indicating open
forums such as these are critically important. The 4th
Annual World Health Congress was held April 22-24, 2007, , in Washington, D.C.
That year many of the world leaders in healthcare concluded that top down
reforming of health care, whether by government or insurance carrier, is not
and will not work. We have to get the physicians out of the trenches because
reform will require physician involvement. The
5th Annual World Health Care Congress was held April 21-23, 2008, , in Washington, D.C.
Physicians were present on almost all the platforms and panels. This year it
was the industry leaders that gave the most innovated mechanisms to bring
health care spending under control. The solution to our health care problems is
emerging at this ambitious Congress. Plan to participate: The
6th Annual World Health Care Congress will be held April 14-16, 2009,
in Washington, D.C. The
5th Annual World Health Care Congress -– Europe 2009, will meet in Brussels, May 23-15, 2009. For more
information, visit www.worldcongress.com. The future is
occurring NOW.
* * * * *
1. Feature
Article: The Patient Safety Crusade--a
Phony Crisis
Written
By: John Dale Dunn, M.D., J.D., Published In: Heartland Perspectives, 2006
The American health care
system is the biggest business sector in the country. As a result, it is a very
attractive target for ambitious politicians and policymakers, with more than $2
trillion a year in expenditures. If an ambitious group of politicians and
meddlers would like to expand government, American health care is the logical
target.
An effective strategy to seal
the deal would be to accuse the health care system of killing people. That
should undermine public confidence and soften people up for the idea that the
government would do a better job.
Toward that end, in 1999 the
Institute of Medicine (IOM), a government policy and science agency, part of
the National Academy of Sciences, published a monograph titled To Err Is
Human (1) and followed
with an extensive public relations campaign accusing American hospital
personnel of negligently killing as many as 100,000 people every year. This
harsh and false criticism of the best hospitals, physicians, and nurses on the
planet has been joined by other government-funded entities and professors at
supposedly independent universities, including many medical academics.
No Crisis
There is no crisis of patient
safety in American hospitals, no epidemic of medical incompetence. As a
longtime medical negligence analyst, I was outraged to read the 1999 IOM news
release and public relations campaign. I had previously analyzed the 1979
California and 1991 Harvard reports that the IOM was relying on and found them
both to show no such crisis.
The IOM campaign actually
commenced before formal publication of the Harvard 1992 study. All the studies
in three separate decades showed no crisis, the same rate of incidents, so
there was clearly no epidemic. The rates of negligent injury were very low for
such a complicated human activity, less than a quarter of a percent
consistently in all the studies. Nonetheless, all the experts were declaring a
catastrophe.
Voices of Reason
Fortunately, the patient
safety crusade and the IOM failed to anticipate the opposition of a nationally
prominent patient safety expert, an honest Harvard physician and attorney named
Troyen Brennan.
Troyen Brennan M.D., J.D. was
the lead Harvard researcher on the two studies that were used as the backbone
of the IOM report. Dr. Brennan wrote in the New England Journal of Medicine in
April 2000, four months after the IOM announcement of a crisis:
·
"I have cautioned
against drawing conclusions about the numbers of deaths in these studies."
·
"The ability of
identifying errors is methodologically suspect."
·
"In both studies [New
York and Utah/Colorado] we agreed among ourselves about whether events should
be classified as preventable. ... These decisions do not necessarily reflect
the views of the average physician, and certainly don't mean that all
preventable adverse events were blunders." (2)
Other safety experts add the
same note of caution. As part of its crusade against non-government health
care, the IOM announced a major safety problem with adverse drug events (ADEs).
Jerry Avorn, M.D., an expert on drug events, writing in the Journal of the
American Medical Association (JAMA), said in an editorial about a couple of
ADE reports: "These two studies push hard at the boundaries of clinical
epidemiology and health services research, and a skeptic might wonder whether
the envelopes of these disciplines might not have gotten a bit nicked in the process."
(3)
Dr. David Bates, another
safety expert, in a Journal of the American Medical Association editorial
commenting on another drug event study, said the ADE studies have problems,
such as whether the events are properly identified and evaluated and whether
they are really avoidable in a practical sense, particularly in severely ill
patients. (4) The millions
of drug administrations daily in American hospitals present an opportunity for
data-dredging and manipulation.
Only Three
Studies
For all the panic that has
been raised, there have been only three patient safety studies, conducted in
1974, 1984, and 1992.
The first study was conducted
by Don Harper Mills, M.D., J.D., a pathologist and attorney for the California
Medical Association. With three associate attorney/physicians, he looked at
care in California hospitals in 1974. They studied about 20,000 patient charts.
(5)
The second study examined
care in New York hospitals in 1984. It was conducted by a group from Harvard
that included Dr. Brennan and Lucien Leape, M.D. They studied 30,000 charts. (6,7,8)
The third study reported on
patient care in Utah and Colorado hospitals in 1992. It was the Harvard group's
second study, led by Dr Brennan. They looked at 15,000 charts. (9-13)
Same Results
All these studies showed the
same results with only slight differences: a 1 percent rate of negligence
events of some kind and less than a 0.25 percent rate of negligent injury or
death.
I reviewed a study of 300,000
hospital charts by the Texas Medical Foundation (TMF) from 1989 to 1992 and
found even lower numbers of negligence and injury in a higher-risk patient
group: the elderly. The California (1974) and Harvard (1984,1992) studies found
a rate of 0.25 percent cases with negligence injury or death. In the TMF study
the rate was even lower, less than 0.2 percent, and the much larger
Utah/Colorado study from 1992 showed some improvement, a decline in the rate of
negligence and injury or death. (14-17)
There is no patient safety
crisis in the United States. Nurses, doctors, and hospitals aren't killers;
they are healers. The current crusade is irresponsible and based on junk
science. It is a malicious lie intended to make way for a government takeover
of the health care system.
John
Dale Dunn, M.D., J.D. teaches emergency medicine at Fort Hood, Texas and is a
resident of Brownwood, Texas. He is a policy analyst for The Heartland
Institute.
To read this article with all the substantiating
references, please go to www.heartland.org/policybot/results.html?artId=20290&CFID=3892739&CFTOKEN=86028232.
* * * * *
2. In the News: Obama’s
Budget Director Orszag's
Health Warning
Democrats are gearing up for a new run at heath
care next year, which is another way of saying that it's an arms race to
promise the most while disguising the costs, says the Wall Street
Journal. Obama's budget director, Peter Orszag was the former head of the
Congressional Budget Office (CBO), and his useful work there on the unchecked
growth of U.S. health spending, especially entitlements, ought to put the cost
issue at the center of the 2009 debate.
According to CBO reports:
·
Government
spending on Medicare and Medicaid is expected to rise to 6 percent of Gross
Domestic Product in a decade, from 4.2 percent of GDP today.
·
In dollars, this
amounts to $1.4 trillion -- nearly 30 percent of the entire federal budget.
·
If costs grow on
pace, U.S. medical spending will rise to 25 percent of GDP in 2025, from 17
percent today.
Adding to this looming catastrophe are plans in
Congress to:
·
Expand the
insurance program for children, which will cost an extra $80 billion over the
next 10 years.
·
Prevent
automatic cuts in Medicare reimbursement fees to physicians at a cost of $556
billion.
But those are nothing compared to the centerpiece
of the universal health care agenda: a "public option" to
provide government insurance for Americans of all ages and incomes.
·
In one scenario,
CBO finds that allowing the nonpoor to buy into Medicaid would cost $7.8
billion over the next decade.
·
If that sounds
like pocket change, keep in mind that Democrats want to make both the public
option and private insurance less expensive for beneficiaries by transferring
extra costs to the government, which would cost an estimated $752 billion.
CBO also finds that programs designed to trim
costs, such as health information technology or comparative effectiveness
research, will produce only modest savings.
Source: Editorial, "Orszag's Health
Warning," Wall Street Journal, December 29. 2008.
For text: http://s.wsj.net/article/SB123051170671838473.html
For more on Health Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=16
* * * * *
3. International Medicine: A Foretaste of the Future of
American Medicine?
Montreal doctor Jacques Chaoulli spent eight years
representing himself all the way up to the Supreme Court where in 2005 he
successfully persuaded the top court to strike down Quebec's ban on private
medical insurance.
Jacques Chaoulli, hero of the
proletariat
Dr
Jacques Chaoulli's Supreme Court win struck a blow for the common man,
according to economist Larry MacDonald's rather unusual reading of the matter,
published yesterday in Canadian Business Online under the title
"Lawyers: Another conspiracy against the laity?" [Canadian
Medicine, November 9,
2008]
The
title comes from a George Bernard Shaw quotation: "All professions are
conspiracies against the laity." (Keep in mind that he also said,
"Every doctor will allow a colleague to decimate a whole countryside
sooner than violate the bond of professional etiquette by giving him away,"
and, "At present, intelligent people do not have their children
vaccinated, nor does the law now compel them to. The result is not, as the
Jennerians prophesied, the extermination of the human race by smallpox; on the
contrary more people are now killed by vaccination than by smallpox." The
US National Library of Medicine has a nice overview of vaccine hysteria,
including George Bernard Shaw's role.)
Montreal
doctor Jacques Chaoulli spent eight years representing himself all the way up
to the Supreme Court where in 2005 he successfully persuaded the top court to
strike down Quebec's ban on private medical insurance. One of his suggestions
for improving the legal system: Canadian lawyers should provide consulting
services for people who want to represent themselves, just like lawyers in the
U.S. do (which is a lower cost alternative to direct representation).
Deborah
Rhode, a Stanford law professor and leading scholar on legal ethics, argues in
her book, Pro Bono in Principle and in
Practice (2005), that lawyers bear an ethical duty to ameliorate
"their monopoly's deleterious effects" by doing more pro bono work
for those who are disenfranchised. After all, "the state-sanctioned
scarcity of legal services" is the reason for their affluence, she writes.
To
be fair, the problem lies not entirely with the law societies. The complexity
of court procedures also contributes to delay and high costs (the Supreme Court
of Canada's Web site has a section on self representation that advises: "
… it is a good idea that you get a lawyer as the procedure is
complicated"). It thus follows that another part of the solution would be
to simplify the tangled web of court procedures.
Until
fees come down, litigants can save themselves a fortune and register a vote
against a cartel-like arrangement by joining the do-it-yourself trend running
through other industries such as investing and real estate services. The great
enabler, of course, is the Internet, which yields easy access to any Canadian
statute, regulation, or case. If you have the time and dedication to do it
right, success is possible, as Chaoulli demonstrated.
http://canadianmedicine.blogspot.com/2007/11/jacques-chaoulli-hero-of-proletariat.html
To read more
about Dr. Chaoulli’s current legal challenges, go to
Chaoulli back in court, but this time it's to
speak about a patient's death in Canadian
Medicine, December 12,
2008.
Canadian Medicare does not
give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R.
791
http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
Physicians and patients owe a great debt to Dr.
Chaoulli. When private health insurance is forced out of the picture in the
United States, will we have a physician with Dr. Chaoulli’s courage?
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. No one can be refused by any hospital.
* * * * *
4. Medicare: Obama Will Ration Your Health
Care
Think of his health plan as a
federal HMO. By SALLY C. PIPES
People are policy. And now
that President-elect Barack Obama has fielded his team of Tom Daschle as
secretary of Health and Human Services and Melody Barnes as director of the
White House Domestic Policy Council, we can predict both the strategy and
substance of the new administration's health-care reform.
The prognosis is not good for
patients, physicians or taxpayers. If Mr. Daschle meant what he wrote in his
book "Critical: What We Can Do About the Health-Care Crisis,"
Americans can expect a quick, hard push to build more federal bureaucracy, impose
price controls, restrict medicines and technology, boost taxes, mandate the
purchase of health insurance, and expand government health care.
In his book, Mr. Daschle
proposes a National Health Board to regulate the way health care is provided.
This board would have vast powers in regulating the massive federal health-care
system -- a system that includes Medicare, Medicaid, and other programs. Under
Mr. Obama, it is likely that that system will be expanded and that new
government insurance for the nonelderly, nonpoor will be created.
Given the opportunity, Mr.
Daschle would likely charge the board with determining which treatments and
drugs are cost effective and therefore permissible to use for patients covered
by the government. And because the government is such a big player in the
health-care market (46% of health-care spending comes from the government), the
board would effectively set parameters for private insurers.
It is nearly certain that the
process of determining which drugs and which treatments would be approved for
use would be quickly politicized. The details of health-care policy may not be
kitchen table conversation, but the fact that a Washington committee can deny
grandma a hip replacement due to her age, or your sister a new and expensive drug,
is. Health care is personal and voters will pressure lawmakers on access to
care.
Liberal experts, Mr. Daschle
included, believe that America needs to ration new technology and drugs. In his
book, Mr. Daschle complains about overuse of new technology and praises the
United Kingdom's National Institute for Health and Clinical Excellence (NICE),
a rationing system that controls government costs. NICE's denial of care is
legendary -- from the arthritis drug Abatacept to the lung cancer drug Tarceva.
These drugs are effective. It's just that the bureaucrats don't consider them
cost effective.
Americans will not put up
with such limits, nor will our elected representatives. Mr. Daschle himself
proves this. He punts the hard decisions about rationing to an unelected board.
Yet his main proposals are not only about expanding subsidized programs to
cover more people but about adding the massively expensive benefit categories
of mental health, which has a strong lobby behind it, and long-term care, which
is important to the broad middle class.
One of the great myths in
health care is that the uninsured are responsible for driving up private
premiums by shifting costs. Uncompensated care certainly shifts some costs to
private payers. Yet these costs are actually quite manageable in the aggregate,
akin to what retailers lose due to shoplifting. The major cost shift is from
government programs -- Medicare and Medicaid -- to private plans. The
government pays doctors to treat Medicare and Medicaid patients. But the rates
it pays, on average, are less than the cost for providing care to these
patients. This is why Medicaid patients, and increasingly Medicare patients,
struggle to find doctors. Putting more people on these programs will
destabilize the remaining private system and create a coalition for price and
wage controls.
Americans will never tolerate
this. Remember our managed-care experiment in the 1990s. It succeeded in its
main goal of controlling costs without an aggregate reduction in health
quality. But in asking Americans to limit their choices, it prompted a
bipartisan act of Congress to provide patients with a Bill of Rights. Now Mr.
Daschle proposes nothing less than a giant HMO with a federal bureaucracy
setting the benefit plan.
Mr. Daschle's model is Massachusetts.
But Massachusetts's plan is an unfolding disaster and demonstrates how Mr.
Daschle's private/public model is merely a stalking horse for
government-dominated health care.
The headline claim is that
the program has signed up 442,000 more people for health insurance. The reality
is that 80,000 of these were simply put on Medicaid and 176,000 more on the
taxpayer-subsidized plans. Costs have exploded, requiring additional tax hikes
and the entire system is only possible due to sizable transfers from the
federal government. The plans are so unaffordable that in 2007, 62,000 people
were exempted from the individual mandate. So much for universal coverage.
The only way the
Massachusetts plan will survive is with continued and increasing federal
subsidies -- that is, tax revenue from the residents of other states. The only
way Mr. Daschle's proposed plan would survive is with massive deficit spending
-- that is, with taxpayer money from future Americans, many of whom are not yet
born.
Mr. Daschle and the Democrats
have spent years developing both the policy and political strategy to make the
final push for taxpayer-financed universal health insurance. They have the
players on the field, a crisis providing a sense of urgency, and a playbook
filled with lessons learned from years of health policy reform disasters --
most recently that of HillaryCare in 1994.
The
big questions for believers in private medicine are at this point political and
strategic. With employers and most insurers reportedly on board with the new
administration's desire for radical overhaul, who will step in to ask the tough
questions? Will these issues get raised in time to provoke a meaningful,
fact-based debate? Americans could easily find that Mr. Obama's 100-day
honeymoon ends with a whole new health-care regime they hadn't quite bargained
for.
http://online.wsj.com/article/SB123060332638041525.html?#
Ms. Pipes, president and CEO of the Pacific
Research Institute, is the author of "The Top Ten Myths of American Health
Care: A Citizen's Guide" (Pacific Research Institute, 2008).
Government is not the solution
to our problems, government is the problem.
- Ronald Reagan
* * * * *
5. Lean HealthCare: 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 study
appears in the latest issue of Health Services Research.
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.
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.
Blackwell
Publishing is the world's leading society publisher, partnering with 665
academic and professional societies. Blackwell publishes over 800 journals and,
to date, has published more than 6,000 books, across a wide range of academic,
medical, and professional subjects. For more information, Contact Sean Wagner
at www.blackwellpublishing.com/.
Article URL: www.medicalnewstoday.com/medicalnews.php?newsid=55560
The Future of Health Care Has
to Be Lean, Efficient and Personal.
* * * * *
6. Medical Mythsisdirection
in Healthcare: 98,000
people die from medical errors each year; 46 million uninsured; 18,000 die due
to lack of insurance; Not one of these statements is true. –Greg Scandlen
Here's
what we wrote, nine long years ago: Report
on health-care errors is unsubstantiated. –Robert J Cihak, MD
Orange County Register
January 23, 2000, Guest column, on page 2 of Sunday's Commentary section
Medical Diagnosis: Crying
Like a Wolf?
Institutions
love to cry wolf when placing blame on someone else. On Nov. 29 last year the
Institute of Medicine leaked a report scaring the public with its claims that
somewhere between 44,000 to 88,000 to 120,000 patients die each year because of
human error.
The
report was widely sensationalized by the press and TV media. It was perfect
fodder for headlines or the 11 o'clock news.
Not
one reporter or editorial writer anywhere challenged the assumptions of the
report.
Even
before this big leak, selective portions of the report were pre-leaked to the
media. The press and public have not seen the whole report and therefore have
not been able to assess its assumptions, methods, results, conclusions or
validity.
To
us, offering a range of 40,000 to 120,000 deaths is hardly precise. We also
note that even the lower end of this range is three times higher than the
National Safety Council estimate.
The
Institute of Medicine is a private nonprofit institution that provides health
policy advice under a congressional charter granted to the National Academy of
Sciences. In other words, it's bought and paid for by the federal government.
Not
surprisingly, within a few days, as if by magic, President Clinton and Sen.
Edward Kennedy had already released their plan to make patients safe again. How
convenient. What fast workers they have in their little hives.
The
members of the committee that created the report just happen to be professors,
administrators, executives and others, all with nice-sounding titles. As hard
as we looked at these impressive credentials there does not appear to be one
person who is a full-time practicing physician. Sort of reminds us of Hillary
Clinton's 1993 Health Care Task Force, which included hundreds of lawyers but
very few practicing physicians.
If
the Institute of Medicine findings are correct, the obvious solution for
absolute, complete prevention of all medical errors would be very simple: just
ban all medical practice in the country.
This
absurd example points to the reason that most people go to the doctor and
hospital in the first place - they hope to improve their condition as a result
of being seen.
Part
of the recommended agenda, according to the press release leak, is to create
'incentives that will lead to a safer health care system.' Their next paragraph
suggests creating a new federal bureaucracy called 'A National Center for
Patient Safety.'
The
track record for most recent government programs is not encouraging. The motto
of many politicians seems to be 'For Every Problem, There's A Program' We
observe that every government program seems to create about twice as many
problems as it addresses, leaving us with three problems.
Even
if the pre-released numbers were correct, could government programs such as
Medicare and managed care practices promoted by the government have something
to do with these fatal errors?
If
bureaucrats limit staffing to half as many nurses, therapists and physicians as
needed to do the job right, and also limit patient encounters to eight minutes,
might these bureaucratic misadventures increase medical errors?
The
Institute of Medicine attempts to curry favor and support by asserting that the
problem is not bad people in health care - it is that good people are working
in bad systems that need to be made safer.
Searching
for safety also has risks; anything done to look for safety takes resources
away from something else.
Requiring
medical people to spend time on additional safety questions, courses and the
perpetual paperwork takes away from the time they can spend examining,
diagnosing and treating patients.
Other
research suggests that diverting resources actually costs lives, in that people
don't preserve their own health as well when resources are taken from them and
wastefully expended by others.
Several
econometric and risk analysis studies estimate that one American dies
prematurely for about every $10 million diverted into wasteful activities.
Until
we get all the facts, and the data undergo scrutiny and analysis, perhaps we
should declare a temporary moratorium on worry for the patients of this
country. Although the sky may appear to be falling, in all likelihood it is
not. Our modest proposal is for everyone to stop crying wolf.
In
the meantime take a deep breath, hold it, exhale, and relax.
Michael Arnold Glueck, MD, a Newport Beach
physician who has written extensively on medical, mental health, and
medical-legal reform issues. Robert J. Cihak, M.D., Aberdeen, Wash., is health
policy analyst for the Evergreen Freedom Foundation in Washington State and is
president-elect of the Association of American Physicians and Surgeons (AAPS).
Copyright
1999 The Orange County Register
Medical
Errors. By Greg Scandlen
They
are tragic when they occur. Certainly hospitals should be places of safety, not
of peril, and hospitals need to deal seriously with issues like medication
errors, preventable infections, and even mundane things like hand washing
between patients. But injecting hysteria is not helpful. One commentator was
quoted as saying, “The equivalent of 390 jumbo jets full of people are dying
each year due to likely preventable, in-hospital medical errors, making this
one of the leading killers in the U.S.” [1] Egads.
In
fact, the 98,000 figure came from a report by the Institute of Medicine, “To
Err is Human.” It was the very top range of an estimate that ranged from 44,000
to “perhaps as many as 98,000” deaths. These estimates are based on exactly two
studies in very localized areas that were then extrapolated to the entire
population. The higher one was based on an examination in 1984 – twenty-four
years ago – of 31,000 admissions in New York that found 173 patients who died
“at least in part because of an adverse event,” according to a review in the
Journal of the American Medical Association (JAMA)[2]. Even the definition of
an “error” was suspect, being based on the opinion of three physicians who
reviewed the medical records. The lead researcher of these two studies, Trowen
Brennan, MD, JD, cautioned against reading too much into his results, as reported
by John Dunn, MD, JD in an analysis published by the Heartland Institute. [3]
The lower estimate of 44,000 deaths is based on a more recent (1992) review of
hospital records in Utah and Colorado that was similarly extrapolated to the
entire population.
Taken together
the two studies might have raised a number of questions the IOM ignored. Such
as, why the drastic difference between New York in 1984 and Colorado/Utah in
1992? The second study found a problem less than half as severe as the first
one. Is medical practice so very different in the two locations? Did conditions
change from 1984 to 1992? [4] <#_ftn4> Is one population at greater
risk than the other? These are provocative questions that would have intrigued
a serious researcher, but the Institute of Medicine had no interest in serious
research. It wanted to rush out with a scary number and did so. But projecting
the one-time experience of a single locality on the entire nation has no
credibility whatsoever.
Whatever
else might be said about the problem of inpatient errors, one thing is certain
– the guesstimate of 98,000 deaths per year is wrong. Yet the media continue to
tout it.
From:
HealthBenefitsReform@yahoogroups.com On Behalf Of Greg Scandlen
Sent: Tuesday, December 23, 2008 9:41 AM
To read Greg Scandlen’s column, go to, Consumers Power Reports.
Well
Meaning Regulations Worsen Quality of Care.
* * * * *
7. Overheard on Capital
Hill: The President
Reads A Book A Week
Bush Is a Book Lover: A glimpse of what the president has been
reading. By KARL ROVE, WSJ
With only five days left, my lead is insurmountable.
The competition can't catch up. And for the third year in a row, I'll triumph.
In second place will be the president of the United States. Our contest is not
about sports or politics. It's about books.
It all started on New Year's Eve in 2005. President
Bush asked what my New Year's resolutions were. I told him that as a regular
reader who'd gotten out of the habit, my goal was to read a book a week in
2006. Three days later, we were in the Oval Office when he fixed me in his
sights and said, "I'm on my second. Where are you?" Mr. Bush had
turned my resolution into a contest.
By coincidence, we were both reading Doris Kearns
Goodwin's "Team of Rivals." The president jumped to a slim early lead
and remained ahead until March, when I moved decisively in front. The
competition soon spun out of control. We kept track not just of books read, but
also the number of pages and later the combined size of each book's pages --
its "Total Lateral Area."
We recommended volumes to each other (for example,
he encouraged me to read a Mao biography; I suggested a book on
Reconstruction's unhappy end). We discussed the books and wrote thank-you notes
to some authors.
At year's end, I defeated the president, 110 books
to 95. My trophy looks suspiciously like those given out at junior bowling
finals. The president lamely insisted he'd lost because he'd been busy as
Leader of the Free World.
Mr. Bush's 2006 reading list shows his literary
tastes. The nonfiction ran from biographies of Abraham Lincoln, Andrew
Carnegie, Mark Twain, Babe Ruth, King Leopold, William Jennings Bryan, Huey
Long, LBJ and Genghis Khan to Andrew Roberts's "A History of the English
Speaking Peoples Since 1900," James L. Swanson's "Manhunt," and
Nathaniel Philbrick's "Mayflower." Besides eight Travis McGee novels
by John D. MacDonald, Mr. Bush tackled Michael Crichton's "Next,"
Vince Flynn's "Executive Power," Stephen Hunter's "Point of
Impact," and Albert Camus's "The Stranger," among others.
Fifty-eight of the books he read that year were
nonfiction. Nearly half of his 2006 reading was history and biography, with
another eight volumes on current events (mostly the Mideast) and six on sports.
To my surprise, the president demanded a rematch in
2007. Though the overall pace slowed, he once more came in second in our
two-man race, reading 51 books to my 76. His list was particularly wide-ranging
that year, from history ("The Great Upheaval" and "Khrushchev's
Cold War"), biographical (Dean Acheson and Andrew Mellon), and current
affairs (including "Rogue Regime" and "The Shia Revival").
He read one book meant for young adults, his daughter Jenna's excellent
"Ana's Story."
A glutton for punishment, Mr. Bush insisted on
another rematch in 2008. But it will be a three-peat for me: as of today, his
total is 40 volumes to my 64. His reading this year included a heavy dose of
history -- including David Halberstam's "The Coldest Winter," Rick
Atkinson's "Day of Battle," Hugh Thomas's "Spanish Civil
War," Stephen W. Sears's "Gettysburg" and David King's
"Vienna 1814." There's also plenty of biography -- including U.S.
Grant's "Personal Memoirs"; Jon Meacham's "American Lion";
James M. McPherson's "Tried by War: Abraham Lincoln as Commander in
Chief" and Jacobo Timerman's "Prisoner Without a Name, Cell Without a
Number."
Each year, the president also read the Bible from
cover to cover, along with a daily devotional.
http://online.wsj.com/article/SB123025595706634689.html?mod=todays_us_opinion
What is Congress Really Saying?
* * * * *
8. What's New in US
Health Care: Creating Lean Healthcare. May 3, 2007, by Jim Womack
Ten
years ago this month I made a visit to the Mayo Clinic’s large medical complex
in Rochester, Minnesota. I was not there as a patient. Instead I was a sort of
lean anthropologist. I was making my first foray into a major medical
organization to examine its thought process and behavior from a lean
perspective.
The
trip was arranged by Dr. Don Berwick, the founder and president of the
Institute for Healthcare Improvement in Boston, who had just convinced me that
I should start LEI as a replacement for my former home at MIT. Don asked me to
ponder a simple question: How would a major medical system go about implementing
lean thinking across all of its activities? (As Don put it, “In healthcare we
have no Toyota to copy. We don’t even have a Yugo. So where do we start?”)
As always, I took a walk.
Over two days I followed a number of patient pathways as well as pathways for
medical supplies, patient schedules, and specimens going through the
laboratories. (Lean Thinkers often call these pathways value streams.) And I
soon reached a diagnosis: Severe sclerosis of patient and support pathways.
At
Mayo (and in the many medical organizations I have visited since), I found
brilliant doctors who were point optimizers, focusing solely on their narrow
activity without much thought (or patience) for how it meshed with the other
activities around them. The hospital’s administrators, by contrast, were asset
optimizers, trying to keep every expensive machine, hospital room, and
specialist busy, even if this meant delays for patients and heavy burdens for
staff. The nurses were the members of the organization thinking about patient
pathways and about core support processes like handling supplies and drugs. But
they were doing this intuitively and reactively to somehow keep things moving.
They lacked recognition of the importance of their task and a rigorous
methodology.
Together, the brilliant doctors, diligent
administrators, and long-suffering nurses were providing healthcare that cost
too much, took too long, and often produced less than optimal outcomes. To make
a lean leap everyone in the organization would need to change their way of thinking
and acting.
My
prescription was very simple: Identify all major patient pathways as well as
support streams. Map them from end to end. Then ask how each pathway can be
cleared of its blockages, backflows, and cul-de-sacs for the benefit of the hospital,
its staff, and its patients. Finally, and most important, ask what changes in
organizational lifestyle will be required to keep the pathways clear.
What
troubled me was not the diagnosis or the prescription. I was pretty sure I was
right. What I worried about was the prognosis. My recommendations would
require everyone—doctors, nurses, and administrators (and suppliers too) -- to
change their behavior and organizational lifestyle. And as medical
professionals know, lifestyle change is usually the hardest part of any
treatment.
Given
the difficulties involved, I ended my first venture into healthcare in May of
1997 thinking it was premature to hope for much progress toward lean
healthcare. And I didn’t return to Mayo for ten years until last week when I
spent a day with Dr. Henry Ting, a cardiologist with a natural instinct for
process thinking. We looked carefully at the work his team has done recently to
speed patients from the point they suspect they might be having a heart
attack—usually far from a hospital—to the point where all appropriate
treatments have been applied.
The
results are quite dramatic. Rethinking this pathway saves lives—many
lives—because the more quickly appropriate treatments are applied the more
likely the patient is to survive and to survive without major heart damage. And
here’s the really encouraging news: A lean pathway reduces costs for the
hospital and makes life better for the staff. It’s a win-win-win. My skepticism
on my previous visit was replaced with hope after this visit.
But
I also realized while flying home that Dr. Ting’s team had performed a
brilliant procedure on one of the easier problems to fix and sustain. They had
analyzed a single pathway and one where the value of saving time is so
overwhelmingly obvious that any medical organization will find it hard not to
change its behavior once the sclerotic state of the existing pathway is clearly
revealed. (Fortunately, their work is now being successfully paralleled
throughout Mayo’s cardiology practice and by similar pioneers along other
pathways in many healthcare organizations across the world.)
The
hard part for all of us is to tie together these pioneering, single-pathway
efforts—which seemed beyond our grasp only 10 years ago. We need to create
a complete lean enterprise in which all pathways have been permanently cleared
and the lifestyle of the organization has been changed as well. This will
require more than lean techniques. It will require new management methods and a
new type of leadership.
Given
the urgent need for this lean leap, I’m truly delighted that my long-time
co-author Dan Jones has taken on the challenge of asking what a truly lean
healthcare system will look like. He is leading the first Global Lean
Healthcare Summit in the UK at the end of June in which we will be asking what
kind of leadership and what kind of management will be required. . .
So
I’m deeply encouraged that Lean Thinkers in the healthcare community are at
last tackling the world’s most important value streams. But I’m also concerned
that we will stop short with single pathway interventions. And I’m worried that
improvements in individual pathways can’t be sustained because the
organizations in which they reside have not changed. What the patient—the whole
healthcare system—really needs is to think through the entire system from a
management and leadership perspective so we can truly create and sustain lean
healthcare.
Jim
Womack, Chairman and Founder, Lean Enterprise Institute
To
read the entire article, go to www.lean.org/Community/Registered/ShowEmail.cfm?JimsEmailId=71
To read more of Jim Womack’s
E-letters, go to www.lean.org/Community/Registered/EmailList.cfm.
* * * * *
9. Health Plan USA: Networking to Develop the
Ideal HealthPlan for the USA
HealthPlanUSA is the network
concerned with bringing the best available ideas to a unified HealthPlan concept
that will help resolve the health care problems in the United States. (Since we
have many readers in the UK, Europe, India, Chile, and Canada,
HealthPlanUK.net, HealthPlanEURO.net, HealthPlanINDIA.net, HealthPlanCHILE.net,
HealthPlanCANADA.net and others will be launched later in 2009 and 2010.) Once
every quarter, we review the progress of the ideal HealthPlan for the USA that
will make HealthCare more affordable for all Americans and their employers, if
an employee benefit exists.
Thank you for joining the
Medical/Professional/Business/InfoTech Gatherings on the FirstTuesday of each
quarter.
The Major Current Problems in
HealthCare
The $2.4 trillion health care industry is the only
major segment of the economy that is failing, and there is nothing the employer,
insurance carrier or government can do about it.
Health care is the only product or service (outside
of public education) that has consistently grown worse over the past 40 years,
with decreasing customer (patient) satisfaction. Every other product and
service in our economy has improved in quality and grown less expensive over
time, with increasing customer satisfaction.
Health care is the only sector of the economy where
prices have been steadily increasing since the end of WWII. Every other sector
of the economy is reaping the benefits of Moore’s Law, which states that the
cost of digital technology decreases by 50 percent every 18 months. In health
care, it is the reverse—less efficient and more costly. For instance, although
the Length of Stay (LOS) for delivery of a child has decreased from four or
five days to one or two days, the hospital cost has more than doubled. The LOS
for gallbladder surgery has decreased from five days to one day, but the
hospital cost has doubled. The surgeons' fees have remained level or even
decreased during this time.
The HealthPlanUSA Solution
HPUSA is the only true Market-based Health Plan
that uses the Internet and Digital Information Technology to bring the
Insurance Carrier, Service Providers (Hospitals, Surgi-centers, Physicians,
Pharmacies, Diagnostic and Treatment Centers), Patients and Credit Providers
together at the same interface, allowing data, information and fund transfers
to occur in real time.
The patient takes an interest in making an informed
decision at every step of the health care process when he or she has a
financial obligation in all decision-making processes–which doctor to see,
which hospital to use, which pharmacy to utilize, which laboratory to use for
testing, which x-ray facility for diagnostic testing, which therapist to use
for physical, occupational or speech therapy. The financial stake is
proportional to the cost incurred without limit. Thus, in turn, each service
provider will provide the best service for the fee involved in order to assure
a continuing customer (patient) base.
The Benefits
·
Healthcare
costs are reduced making it more affordable and available to all Americans,
thus eliminating the uninsured concerns.
·
Quality
is increased by cutting down delays in patient care, thus decreasing
unnecessary patient suffering and premature death.
·
Spectrum
of a customer market base is increased to insurance and credit providers by the
direct digital interface with the patient and service providers.
·
Efficiency
is increased by cutting the time between providing medical services and payment to service providers:
hospitals, surgi-centers, physicians, pharmacies, laboratories for x-ray, CTs,
MRIs, and other diagnostic and treatment centers. Secondary and tertiary
billing, denial of service and further billing has been relegated to the
dustbin of history. This duplicative and triplicate cost is difficult to
ascertain because currently this cost is difficult to document or analyze, is
not available, is not transparent, or is hidden. Actuaries that are working for
large health insurance companies have informally estimated that this will be a
30-50 percent decrease in business office costs for hospitals, physicians and
other providers.
·
Choice
is unlimited as patients make their own choice on the basis of cost, quality
and efficiency. Unless they improve, inferior or incompetent providers will be
eliminated more efficiently by the simple procedure of changing providers. This
will be more effective than any HMO, insurance plan, PEER Review, government program,
Medical Board or other overseeing or policing agency can provide, thus saving
multiple bureaucratic costs which further decreases health care costs. Patients
monitoring their own health care costs is the most effective, and sometimes
even ruthless, cost deterrent. Inferior providers are simply eliminated due to
lack of patients and are forced to look for other employment. Some insurance
actuaries have informally admitted this could eliminate up to 90 percent of
current quality assurance costs.
·
The
cost becomes extensive due to provider panels, provider credentialing, the army
of nurses and reviewers looking over every hospital admission - reviewing
charts daily, controlling every consultation or diagnostic procedure,
controlling outpatient consultations and patient evaluations, reviewing and
authorizing or denying every surgical procedure, reviewing every CPT and ICD 9
code, and reviewing patient charts for adequacy. Although accurate data is
elusive, some actuaries have informally estimated a profound decrease in
administrative and bureaucratic cost approaching 80 percent of current
surveillance costs.
·
The
nation's $1 trillion privately funded health care costs (of the $2.4 trillion
total) will be significantly reduced. Although accurate data is inconclusive,
conservative estimates by actuaries suggest the nation's health care costs
should be reduced by at least thirty to forty percent, making health care
affordable to all Americans that fall between the Medicaid and Medicare
programs. As Medicare goes bankrupt and eliminates 66 and 67 year olds,
progressing higher as it follows social security benefit restrictions,
HealthPlanUSA will easily be able to absorb these unfortunate Americans who
have lost an unrealistic unfunded coverage base.
·
With
patients involved and monitoring their own health care with direct access to
all their lab work, x-rays, procedures and medical reports, liability will
plummet. Malpractice insurance will drop at least 50 percent within one year of
experience and for medical specialists, it will be on the order of their car
liability or house, fire, earthquake and flood insurance. This will be a huge
savings for physicians and other service providers.
Welcome to an Exciting Journey
We appreciate your participation as we step back each
quarter to reflect on where health care has been and just what the ideal
HealthPlan might be for the USA and any country wanting to privatize and
personalize their HealthCare. As we discuss various issues in our attempt to
understand the health care problems for Americans, we welcome your thoughts and
ideas in our efforts to create the ideal HealthPlan for the United States and
the world. The subject is huge. Although the email response has been
overwhelming, we do look over every email and all of your ideas and suggestions
will help formulate the future of our country. We will also have a blog link
for your direct participation and dialog located on our header.
If you would like to participate or be an investor
in an innovative health plan for our country’s future, please send a personal
email with your business and professional qualifications to DelMeyer@HealthPlanUSA.net
or SatyamPatel@HealthPlanUSA.net.
©
Del Meyer, MD 1/2009
Share: 
Digg ; Del.icio.us ; Facebook ; 
Newsvine ; My
Web ; 
MySpace
Current Issues Being Studied
* * * * *
10. Restoring Accountability in Medical Practice by Non-Participation in
Government Programs and Understanding the Devastating Force of Government
Medicine and Liberty - Network of Liberty Oriented
Doctors,
www.MedLib.ch/ Alphonse Crespo, MD, Executive Director and Founder
·
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
·
Medicine and
Liberty - Network of Liberty Oriented Doctors, www.MedLib.ch/, 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
·
Americans for
Tax Reform, www.atr.org/,
Grover Norquist, President, ke of Americans
for Tax Reform, www.atr.org/, keeps
us apprised of the Cost of Government Day® Report, Calendar Year 2008. 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 2008 was July 16th, a
four-day increase above last year’'s revised date of July 10th. With
July 16th as the COGD, working people must toil on average 197 days
out of the year just to meet all the costs imposed by government. In other
words, the cost of government consumes 53.9 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.
·
National
Taxpayer's Union, www.ntu.org/main/, Duane Parde,
President of the National Taxpayer’s Union, www.ntu.org/main/, keeps us
apprised of all the taxation challenges our elected officials are trying to
foist on us throughout the United States. To find the organization in your
state that'’s
trying to keep sanity in our taxation system, click on your state at www.ntu.org/main/groups.php.
·
FIRM: Freedom and
Individual Rights in Medicine, www.westandfirm.org, Lin Zinser,
JD, Founder, www.westandfirm.org, researches
and studies the work of scholars and policy experts in the areas of health
care, law, philosophy, and economics to inform and to foster public debate on
the causes and potential solutions of rising costs of health care and health
insurance.
·
Ayn Rand, The Creator of a Philosophy for Living
on Earth, www.aynrand.org/site/PageServer,
is a veritable storehouse of common sense economics to help us live on earth.
To review the current series of Op-Ed articles, some of which you and I may
disagree on, go to www.aynrand.org/site/PageServer?pagename=media_opeds.
* * * * *
Thank you for joining the
HealthPlanUSA network of 80,000 professionals that receive our newsletter and
visit our websites. Stay tuned for the latest innovating thinking in HealthCare
and have your friends do the same.Stay Tuned to the
HealthPlanUSA Networks and have your friends do the same.
Articles that appear
in HPUSA may not reflect the opinion of the editorial staff. Sections 1-5 are
entirely attributable quotes in the interest of the health care debate.
Editorial comments
are in brackets.
PLEASEALSO NOTE:
HealthPlanUSA receives no government, foundation, or private funds. The entire
cost of the website URLs, website posting, distribution, managing editor, email
editor, and the research and writing is solely paid for and donated by the
Founding Editor, while continuing his Pulmonary Practice, as a service to his
patients, his profession, and in the public interest for his country.
Spammator Note: HealthPlanUSA
uses many standard medical terms considered forbidden by many spammators. We
are not always able to avoid appropriate medical terminology in the abbreviated
edition sent by e-newsletter. (The Web Edition is always complete.) As readers
use new spammators with an increasing rejection rate, we are not always able to
navigate around these palace guards. If you miss some editions of
HealthPlanUSA, you may want to check your spammator settings and make
appropriate adjustments. To assure uninterrupted delivery, subscribe directly
from the website rather than personal communication: www.HealthPlanUSA.net/newsletter.asp
* * * * *
Del Meyer
Del Meyer, MD, CEO & Founder
DelMeyer@HealthPlanUSA.net
Satyam A Patel, MBA, CFO, & Co-Founder
SatyamPatel@HealthPlanUSA.net
HealthPlanUSA,
LLC
www.HealthPlanUSA.net
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words
of Wisdom & Reality
Othello: “Our bodies are gardens and our minds are the gardeners.” –William
Shakespeare
Congressman: I run an organization that’s billions in
debt. I may be incompetent, but I won’t give up any perks and pay like those
losers in the auto industry. In fact, I’ve given myself a raise. –Kirk Walters, The Toledo, Ohio Blade.
"The
environment you fashion out of your thoughts, your beliefs, your ideals, your
philosophy is the only climate you will ever live in." — Dr. Stephen Covey: Personal development author, speaker, consultant.
Some
Recent HeadlinesPostings
One
Woman's Trash Is Another Woman's...Lingerie?
As
Salt Prices Rise, Frozen Towns Reach for Molasses
Green
Revolution Hits Dead End In Georgia Cemetery Proposal. Elizabeth Collins, a gardener, birdwatcher and a
self-described "renaissance woman," wanted to start a
"natural" cemetery where bodies would be buried without embalming,
coffins or vaults. Ms. Collins Thought Natural Burials Were a Killer
Idea; Locals Saw Grave Threat.
This
DateMonth
in History – January 1
January 1st
is the day when resolutions and hope are put to the test. Will it be a day of
good intentions and a journey of triumph for good? Or will it just be another
year in our lives? Lincoln issued his Emancipation Proclamation on this date in
1963. Brooklyn merged with New York in a single city in 1898. Twenty-six
nations signed the United Nations Declaration in World War II in Washington, D.C. in 1942. It is also the
birthday of Paul Revere (1735), Betsy Ross (1752), and General Anthony Wayne
(1745). College Football Bowl games could no longer all be played on this day
as the number grew from the original four to more than twenty, taking most of the week to
complete. The first successful heart transplant operation was performed in
South Africa on Jan 2, 1968. The first successful appendectomy was performed in
Iowa on Jan 4, 1885. On this date in 2005, President Bush resolved to read one
book a week and did read one every 5 days. He also continued to read the Bible
completely through every year. Maybe we should all resolve to match our
outgoing President in his resolutions so successfully completed. That would
make all of us better individuals, improve our education level, and make our country a better place in
which to live. Best wishes for a Joyous and Exciting New Year. –Del Meyer, 2009