Community For Affordable Health Care

Vol IX, No 4, January, 2011

Transforming the $3 Trillion HealthCare Industry into Affordable HealthCare

By Utilizing the $2 Trillion Information Technology Industry

Through innovation by moving from a Vertical to a Horizontal industry

Thus eliminating $1 Trillion wasted

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

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

In This Issue:

1.         Featured Article: A Free and Prosperous New Year by David Boaz

2.         In the News: The proper role of government in financing and delivering health care

3.         International Healthcare: The Future Of Healthcare

4.         Government Healthcare: Obamacare

5.         Lean HealthCare: Changing Healthcare Culture to Continuous Improvement

6.         Misdirection in Healthcare: How to correct the current misdirection?

7.         Overheard on Capital Hill: America needs “Someone to Trust.”

8.         Innovations in Healthcare: All innovations may not be improvements

9.         The Health Plan for the USA: Planning the Patient-Centered Health Plan for America

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

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Have a Happy, Healthy, and Prosperous New Year 2011
 We wish each and every one of you a Happy, Healthy and Prosperous New Year in 2011, as we seek to restore the Private Patient-Centered Medical MarketPlace that will deliver healthcare to all most effectively.

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

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1.         Feature Article: A Free and Prosperous New Year by David Boaz

This article appeared on on January 6, 2005.

The sun rises in 2005 on the freest and most prosperous world in history.

According to Economic Freedom of the World: 2004 Annual Report, the average economic freedom rating for 123 countries rose from 5.1 in 1980 to 6.5 in 2002, on a scale from 1 to 10, with 10 representing full economic freedom. China showed a particularly strong move in the direction of economic freedom, moving from 3.8 in 1980 to 5.7 in 2002 (down slightly from 5.9 in 2000). But other countries also moved toward economic freedom, notably Australia, Chile, El Salvador, India, Ireland, Mauritius, New Zealand, and Uganda.

Hong Kong was rated the freest economy in the world, but it declined slightly from 9.1 in 1995 to 8.7 in 2002.

The authors of the report, published by the Fraser Institute in Vancouver, pointed to several ways in which economic freedom has grown: Read more . . .

  • The use of extremely high marginal tax rates fell sharply. In 2002, not a single country imposed a 60 percent marginal tax rate on personal income; in 1980, 49 did so.
  • Exchange-rate controls were liberalized substantially. In 2002, there were only four countries with black-market exchange rate premiums of 25 percent or more compared to 36 countries in 1980.
  • Tariffs were reduced. In 2002, the mean tariff rate was 10.4 percent compared to 26.1 percent in 1980.
  • Controls on both capital markets and interest rates were relaxed.

Over the past 25 years, several factors have contributed to the growth in economic freedom. The collapse of the Soviet Union allowed Russia and its former colonies to give their citizens more freedom. Ronald Reagan and Margaret Thatcher challenged the concept of ever-bigger government and showed that tax cuts and privatization can create prosperity. The spread of world trade -- often called "globalization" -- brought more countries into the world economy and gave their citizens more comfortable lives.

All those trends should continue. On Ronald Reagan's 93rd birthday last February, China's deputy finance minister Lou Jiwei told the Wall Street Journal that China would cut tax rates. "It's a lot like Reaganomics," Lou said. "We feel that only through simplifying things and lowering tax rates will revenue collection become more efficient."

Countries compete more than ever to attract businesses, investors, and citizens. High tax rates, capital controls, and excessive regulation drive investors away, so many countries have been trying to cut taxes and regulation. "Tax competition" helps protect taxpayers from their own governments.

But there are powerful forces that resist the call for less government. The European Union started as a free-trade area -- it was first known as the Common Market -- but today it is largely a giant cartel for high taxes. Its leaders try to "harmonize" tax rates by pressuring member countries with low taxes to raise them.

President Vladimir Putin has been tightening restrictions on press freedom in Russia and also moving to reverse some of the post-Soviet industrial privatization. The arrest of Yukos CEO Mikhail Khodorkovsky and the renationalization of part of Yukos serve as a powerful warning to other Russian executives and to international investors.

Africa and the Arab world still have not tasted much economic freedom. Despite the Bush administration's promise to bring democracy and free enterprise to Iraq, progress in Arab countries looks likely to be very slow.

The Bush years have been a mixed bag for economic freedom in the United States. Tax rates have been cut, but government spending has soared -- a combination that can't go on forever. Since his reelection, President Bush has promised to let American workers invest their Social Security taxes in private retirement accounts. If Congress goes along, that would be the biggest boost for economic freedom in many decades.

Hong Kong is in a curious position: It is the freest economy in the world, but it is now part of a country run by the Communist Party. Although China's economy is getting more free, Beijing is exerting more control over Hong Kong. That creates great risks for both freedom and prosperity in Hong Kong.

We must not forget the real importance of economic freedom. Besides the value of freedom itself, economic freedom leads to economic growth. And growth is not just an abstract concept. It means that women have running water, rather than having to carry water from a well that may be miles away. It means enough food for children. It means medical care and dramatically lower rates of infant mortality.

The hurricanes that devastated Haiti earlier this year and the Asian tsunamis last week both reminded us of the real costs of poverty. It is the lack of wealth that forced so many people to live in homes that could be easily destroyed by hurricanes and tsunamis. Economic freedom means more wealth for the whole society, which means better-built homes and better warning systems in case of disaster.

For those of us who want the poorest people in the world to have better lives, the challenge is to continue the spread of globalization, resist tax cartels, and give more people more opportunity to own stocks, bonds, and other real assets.

David Boaz is executive vice president of the Cato Institute and author of Libertarianism: A Primer (Free Press, 1998).

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2.         In the News:  The proper role of government in financing and delivering health care

Ten Principles of Health Care Policy  By: Joseph Bast

Published In: Legislative Principles > Health Care Policy > 06/01/2007 Publisher: The Heartland Institute

The proper role of government in financing and delivering health care is one of the hottest public policy issues of our time. Some experts call for more regulation and more subsidies, while others call for less. All levels of government in the U.S. are coping with rising spending on health care for their own workforces and rapidly rising spending on programs for the poor and elderly.

This booklet is designed to help state legislators find solutions to health care problems by first identifying their causes and true extent--which often are not as they are reported in newspaper stories or touted by special interest groups--and then by presenting 10 principles that ought to guide reform efforts. Read more . . .

Do we really spend too much?

It often is assumed at the outset that “we spend too much” on health care in the U.S., but who is “we” and what is the “right” amount? Individuals, not nations, earn income and choose how to spend it.

When adjusted for inflation, per-capita health care spending in the U.S. today is about 10 times what it was in 1950. By itself, this statistic is not evidence of a problem. Data from around the world show that people tend to spend a bigger part of their incomes on health care as they grow wealthier (OECD 2004). Health is what economists call a “superior good,” which means spending rises faster than income.

Spending on health care in the U.S. totaled $1.9 trillion in 2004--an average of $6,430 per person, almost one-sixth of the nation’s gross domestic product (NCHS 2006). No doubt some of this increased spending has produced good results. Higher spending on health care is responsible for some part of the significant increases in lifespan and reduced disability during the past half century. Most spending today is on treatments that were unavailable at any cost in the not-so-distant past (Cutler 2004, Gratzer 2006). Health care providers in the U.S. provide a higher level of care than is available in most, and perhaps all, other countries (Brase 2000).

Reasons we spend so much

Spending on health care in the U.S. often is compared unfavorably to spending levels in other countries, but there are some good reasons having little or nothing to do with public policies that help explain why health care in the United States costs more than it does in other countries. Among them:

· We invest much more in saving prematurely born infants and extending the life of our elderly. Other countries withhold care and stop treatment (Wesbury 1990, Wennberg 2006).

· Pregnancy, birth, and abortion rates among girls aged 15 to 19 are higher in the U.S. than in other developed countries (Singh and Darroch 2000).

· The portion of the U.S. population aged 15 and older that is obese is nearly double that of Canada and substantially higher than in other wealthy countries (Anderson and Hussey 2000).

The need for health care reform

Even knowing that a high level of spending on health care is not necessarily a bad thing, and that there are reasons why we spend more than consumers in other countries, we might still conclude that we spend too much on health care in the U.S. In fact, we should come to this conclusion.

Waste and inefficiency are easily identified in our hospitals, government programs, and private insurance markets (Meier 2001b). We see it in the number of people who lack health insurance, the lack of price transparency in much of the health care system, the high rate of medical mistakes in hospitals, and the massive transfers of income--often from the poor and uninsured to the well-to-do and insured--that the current system generates.

A “good health care system” wouldn’t employ armies of “gatekeepers” to intrude in the relationship between doctors and patients, wouldn’t require lawsuits to ensure that victims of malpractice get adequate compensation or that incompetent providers lose their licenses, and wouldn’t ration access to life-saving drugs. . .

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3.         International Healthcare: From the Stockholm-Network of Think Tanks


Paul Healy, senior researcher of the Stockholm Network

Healthcare systems today are more adept than ever at keeping patients healthier for longer. Since 1961, life expectancy at birth in the OECD has increased by over 11 years on average, which means that a person born in the OECD can now expect to live beyond 80 years of age. . .

More accessible healthcare

Modern consumer habits mean that today’s patients are much more demanding of easy-to-access healthcare treatment. No longer are patients willing to accept long waiting lists for operations, time-consuming booking systems for family doctors or an inability to access medical opinion at the touch of a button. This inclination is not necessarily because patients are unacceptably insistent today but because they recognise that such obstacles are no longer necessary. . .

More personalised healthcare

If eHealth can be rolled out further then this would certainly fulfil another demand of patients: the desire for more personalised treatment. No longer do patients want to be treated as a homogenous mass, primarily because they have realised that medical evidence proves that they in fact are not all the same.  Whilst one-size-fits-all healthcare can have its advantages in areas of public health, such as immunisation, the reality is that most diseases are much more complex.

Semashko healthcare systems during the Cold War, which were entirely socialised, proved woefully inadequate in dealing with individually treating patients and life expectancy, as a result, lagged far behind Western healthcare systems by 1990. . .

On average, current health spending per capita in the most developed countries is 19 times the amount that it was in 1970. As a percentage of GDP, health spending has also grown considerably since 1970. . .


So it becomes increasingly obvious then that healthcare systems are likely to change. Whilst it is encouraging that such developments are going to be designed to keep people alive for longer, such progress will inevitably come at a cost. Therefore, policymakers should be looking to pre-empt changes in healthcare and aiming to install reforms that will better accommodate such changes.

The best way to prepare for more accessible, effective and personalised treatments would be to implement reforms now that make the current healthcare system more accessible, effective and personalised. To do this, patients need be empowered.

In financing healthcare, there needs to be a greater balance between private and public funding, allowing for more flexibility and choices. Furthermore, there needs to be a reform of the relationship between patients and their health services, which could turn the emphasis towards what patients want. Last but not least, further competition in health services will increase accountability of such services to patients.

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

Euro-Care is beginning to recognize the economic value of patient empowerment and private care.

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4.         Government Healthcare: Obamacare - This Cannot Stand

Consumer Power Report > 2011 > Health Care > Consumer Power Report

Written By: Benjamin Domenech Publisher: Consumers for Health Care Choices at The Heartland Institute

Welcome to the first Consumer Power Report of 2011.

This New Year has brought an influx of new Congressmen in Washington and new state legislators and governors across the country. For many, the first topic of conversation when they enter these halls of the republic concerns health policy and entitlement reform. Read more . . .

In the next few days on Capitol Hill, we’ll see the first major vote to repeal President Barack Obama’s health care law. This is a vote that must happen, and ought to be politically easy given the jobs numbers involved – it’s a sign of commitment to the reason many of these new members got elected. What’s more critical is a vote that will come later, one that some observers and pollsters will declare must not happen politically – a vote that will offer America a clear choice about our budgetary future under the leadership of Budget Chairman Paul Ryan (R-WI).

. . . So often in prior congresses, conservatives could not sway their hand-wringing colleagues to take firm stands in favor of balanced budgets, entitlement reform, and an approach to health policy reform that empowers individuals within open markets. We’ve seen the consequences of this failure: a budget picture that is growing worse with each passing day, a health care system in desperate need of reform, and a deficit graph line that expands with the entrance of the Baby Boomers into Medicare like a pig in a python.

This cannot stand, or we will reap the consequences.  .  .  new legislators in Washington should take their cue from the boldness of the states, where it’s far more difficult to play shell games with budgets. This honesty breeds defiance, and I expect we will soon see governors, Democrats and Republicans, banding together to demand more flexibility from Washington as they await the outcome of the court challenges.

Every week I talk to more state legislators asking what they can do to battle back against Obamacare. Grace-Marie Turner has written an excellent column for Health Care News describing nine steps, which I strongly recommend as a starting point. Not all these votes will be politically easy – but it’s those votes, after all, that you were elected to make.

-- Benjamin Domenech

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

- Ronald Reagan

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5.         Lean HealthCare:  Changing Healthcare Culture to Continuous Improvement

On the Mend: Putting culture change at the heart of a lean healthcare transformation
Originally presented: September 13, 2010 (permalink)

Part case study, part manifesto, this groundbreaking new book by a doctor and a healthcare executive uses real-life anecdotes and the logic of lean thinking to make a convincing argument that a revolutionary new kind of healthcare — lean healthcare — is urgently needed and eminently doable. Read more . . .

In On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry John Toussaint, MD, former CEO of ThedaCare, and Roger A. Gerard, PhD, its chief learning officer, candidly describe the triumphs and stumbles of a seven-year journey to lean healthcare, an effort that continues today and that has slashed medical errors, improved patient outcomes, raised staff morale, and saved $27 million dollars in costs without layoffs. Find out: Read more . . .

· How lean techniques of value-stream-mapping and rapid improvement events cut the average “door-to-balloon” time for heart attack patients at two hospitals from 90 minutes to 37.

· What ThedaCare leaders did to replace medicine’s “shame and blame” culture with a lean culture based on continuous improvement and respect for people.How the lean principle of “building in quality at the source” broke down divisions among medical specialties allowing teams to develop patient care plans faster.

· Why traditional modern management is the single biggest impediment to lean healthcare.

· How the plan-do-study-act cycle coupled with rapid improvement events cut the wait time at a robotic radiosurgery unit from 26 days to six.

· How the lean concept of “one piece flow” saved time in treating ischemic stroke patients, increasing the number of patients receiving a CT scan within 25 minutes from 51% to 89%.

· How senior leaders at other healthcare organizations can begin their own lean transformations using a nine-step action plan based on what ThedaCare did — and what it would do differently.

Toussaint and Gerard prove that lean healthcare does not mean less care. On the Mend shows that when care is truly re-designed around patients, waste and errors are eliminated, quality improves, costs come down, and healthcare professionals have more time to spend with patients, who get even better care. Get your copy of this important new book today.

If you have questions or comments for the authors of On the Mend, you can call 920-735-7213.

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

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6.         Misdirection in Healthcare: How to correct the current misdirection?

The Conservative Way Forward on Health Care

Posted on by admin

By: Richard Amerling, M.D.,

The landslide Republican victory, in taking the House and electing some strong conservatives to the Senate, can be interpreted as a mandate to rein in government spending, and specifically to repeal ObamaCare, as these issues were clearly behind the large turnout. There is still a very real possibility the Supreme Court will find the “individual mandate” to buy private insurance unconstitutional. If this provision is thrown out, it’s hard to see how the law survives, since the mandate is needed to finance it.

Now is an excellent time to construct a conservative alternative vision for true reform of our health care delivery system. Since most current problems with the health care system stem from government, a conservative plan should seek to reduce its role.Read more . . .

It goes without saying that the Patient Protection and Affordable Care Act must be repealed since, like all the laws passed by this administration, it does precisely the opposite of what its name suggests. By massively increasing the health care bureaucracy at the expense of actual providers of care, it will make care harder to access and more expensive. Many physicians will take early retirement and the already great physician shortage will be exacerbated.

The law is too large and complex to waste time foraging for items to salvage. There is a great risk of leaving behind hidden mandates and rules that will be harmful. Better to scrap the whole thing. With Democrat Senators running scared for their jobs in 2012, it is conceivable the Senate would also vote for repeal (Harry Reid notwithstanding). But not even the most generous view of Barack Obama’s ideological flexibility has him signing a repeal bill, and a veto override is out of the question for now.

It may be possible, however, to enact affirmative measures that make ObamaCare irrelevant. Here are some common sense, free market proposals, many of which were proposed and discussed, but ignored by the President and the Congressional leadership in the run-up to passage of ObamaCare.

1. Transfer the tax deduction for health care spending from employers to individuals. This would end the absurdity of purchasing health insurance at the “company store,” a practice that limits individual choice and liberty, nourishes a sense of dependency, and promotes overuse of care. This policy, an accident of WW II wage and price controls, was the “original sin” in health care financing; doing away with it would empower consumers to shop for the best plan for their families, which will lower premiums.

2. Remove barriers to the interstate sale of health insurance. There is broad agreement on this proposition. It would increase choice and competition between insurers and drive down premiums by effectively ending state mandates that drive them up.

3. Deregulate and allow greater contributions to Health Savings Accounts. These fabulous tax shelters give individuals more control over their health spending, and, coupled with an inexpensive policy to cover catastrophic illness (i.e., true insurance), are all most people need. By returning most health care purchasing decisions to consumers, spending will immediately be slowed and prices curbed. This is the conservative, free market, already tested and proven way to “bend the cost curve down.”

4. Follow the recommendations of the bipartisan Breaux Commission and give Medicare beneficiaries a means-tested stipend to buy private insurance. This solution came during the Clinton era but was too free-market to pass muster with Bill and Hillary. With Medicare moments from insolvency, there should again be a bipartisan consensus to reform this behemoth.

5. Transfer (gradually) all Medicaid responsibility to the states. Federal support for Medicaid allows much greater spending than would otherwise occur. It forces frugal states to subsidize lavish coverage in New York, California, and elsewhere. States should have complete freedom to organize their Medicaid systems along their own priorities, in exchange for losing, over perhaps five years, the federal subsidy. This would encourage states to find innovative ways of providing health insurance for the poor, such as individual health accounts, or subsidies to buy private insurance.

The latter two points would allow the mammoth Center for Medicare and Medicaid Services to be mothballed, though Medicare could retain a role as insurer of last resort for those with pre-existing, expensive, chronic diseases.

6. Institute a “loser pays” system for medical malpractice to cut frivolous lawsuits. The ability to launch a lawsuit (and this applies beyond medical malpractice) with minimal financial risk is the reason behind the explosion of malpractice litigation, with all the associated costs. Tort reform at the federal level would require the Senate to override the trial lawyers’ veto, which could be a problem. This reform should be pushed at the state level.

7. Finally, for true patient protection, let’s propose a constitutional amendment to guarantee the individual’s right to privately contract for medical care. This will eliminate for all time the threat to the private practice of medicine and assure that, no matter what system is in place, patients will always be allowed to spend their own money on care.

The above points are clear, simple and practical solutions. They empower the individual and greatly reduce malignant government influence and unburden the taxpayer. It is the conservative way forward on health care.

Richard Amerling, MD is a nephrologist practicing in New York City. He is an Associate Professor of clinical medicine at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians’ Declaration of Independence (

Watch Clip of Dr. Amerling at National Doctors Tea Party Aug, 7, 2010:

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Well-Meaning Regulations Worsen Quality of Care.

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7.         Overheard on Capital Hill: America needs “Someone to Trust.”

Wanted: Someone to Trust

Paul Johnson, 11.18.10,
Forbes Magazine December 06, 2010

What the midterm elections proved is that the American people do not trust Barack Obama to lead them. And trust, that magic five-letter word, is the most important element in the relationship between a nation and its government.

Trust has been of central importance in American history. During the long and exhausting War of Independence the American people gradually learned to trust George Washington. They subsequently were happy to have him preside over the process of governing that led to the writing of the U.S. Constitution.

The more one reflects on that wonderful document the more extraordinary appears its birth. Washington felt this at the time, saying it struck him as "little short of a miracle, that the delegates from so many different states . . . should unite in forming a system of national government, so little liable to well-founded objections." He further said: "It approached nearer to perfection than any government hitherto instituted among men [and was] provided with more checks and barriers against the introduction of tyranny . . . than any government [previously devised by] mortals." He later concluded that it came into being under "the invisible hand" of Providence.

The central reason that the delegates were prepared to accept the Constitution and the states subsequently ratified it was that Washington was in charge of the process. He was the one man they all trusted. Read more . . . That trust proved to be justified. During Washington's two terms as President he showed that the Constitution was workable; he then stepped down--without argument or fuss--and made way for another. By then the Constitution had become a living thing, an organized part of America.

Trust is always the best contract between a government and its people. It does not need to have a constitutional basis or legal definition. But it needs to be felt in the hearts and minds, the blood and bones. And it is reciprocal. A leader will never be trusted until he or she shows, by attitude and conduct, that he or she in turn trusts the people.

I remember feeling this as a boy in 1940, when Britain was in danger of being drowned in the rapidly advancing tide of Nazi military success. We trusted Winston Churchill to save us, and he, in turn, trusted the British people to have the courage and endurance and the intelligence and strength to make salvation possible.

I had a sense of déjà vu at the end of the 1970s. Britain was in an appalling state, with militant trade unions rendering elected governments impotent, while the economy was sliding into bankruptcy. For the first time in our history we chose a woman to be prime minister. Slowly the people's relationship with Margaret Thatcher became one of trust--and was strengthened over the course of some nasty and brutal attempts by the unions to overthrow constitutional government. The trust was justified: After a dozen years under the Iron Lady, Britain emerged strengthened and invigorated.

In the U.S. something similar happened. The 1970s had also been a disastrous decade there, marked by a collapse in the nation's self-confidence. When Ronald Reagan first emerged on the national scene many dismissed him as a second-rate movie actor. Gradually, however, trust built up. When Reagan was elected to a second term he secured the enormous tally of 54,455,075 votes--nearly 60% of the total--carrying 49 states and winning 525 votes in the electoral college.

The processes of earning and granting trust are gradual and almost metaphysical. So it is that a good leader, at some point, ceases to be merely a politician, an officeholder; he or she becomes a trusted institution. And from that point on the nation becomes healthier, more secure and thus happier. . .

As for the U.S., at few times in its history has it stood in greater need of a leader it can trust. The scars from the financial crisis are still raw and unhealed; unemployment is a cruel scourge; and there are terrible threats to the country's internal and external security, with the future overshadowed by emerging superpowers and competitors. And there is no one to trust.

The U.S. has all kinds of problems. But its biggest over the course of the next two years is how to find a leader who will inspire through character and integrity, vision and resolution, courage and judgment the belief, faith and confidence that Americans have always warmly given to the right person--someone they can trust.

Paul Johnson, eminent British historian and author; Lee Kuan Yew, minister mentor of Singapore; Amity Shlaes, senior fellow in economic history at the Council on Foreign Relations; and David Malpass, global economist, president of Encima Global LLC, rotate in writing this column. To see past Current Events columns, visit [the] site at

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What are the President and Congress Really Saying?

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8.         Innovations in Healthcare: All innovations may not be improvements

All innovations are not equal. At the present time, there is considerable misunderstanding between digital medical records, which I presume essentially all physicians that type their consultations and medical reports using a computer word processing system utilize vs a fully electronic system. The individualized local digital records allow retrievable records across all office, group and clinic networks. This allows any doctor on the network to access a patient’s medical record even if the chart is temporarily misfiled or in another partner’s office. It also allows for irregular patients or those seen infrequently in consultation to have a continuous digital record when they do come in, even if five years after the initial consult.

To have electronic ordering of tests, x-rays, scans, pulmonary function testing, with the reading of this report on the same interface, requires considerably more sophistication. There are many opportunistic entrepreneurs who are selling doctors programs that allegedly can do all these things. But over the past several years with all the government meddling into medical records, many physicians have invested to their detriment. They did not save money or time. They actually spent a lot of money and experienced greater loss of valuable time, which resulted in being even more costly than the investment.

This is not unique to health care, but in all large programs. There is something about the word “computer” that acts like a “soporific” –or at least tranquilizes the tension of being overwhelmed for a short period of time. And then the crises hits—the programmers let out reality thinking that the purchased program will not function as contracted and cannot be altered to function as promised. There have been several departments in California where this has happened. The one that comes readily to mind is the Department of Motor Vehicles. After spending $50 Million, as I recall, they gave up and had to start over from scratch.

But most medical establishments don’t have access to taxpayer’s money and cannot afford to make such costly errors. Hospitals, which have access to taxpayer’s monies, sometimes can. In fact, there is one hospital in Sacramento that has just such a white elephant, but doesn’t know it yet. Doctors and nurses have to be trained, retrained, updated, and when coming back from leave or vacation, need a review course because none of the program is friendly or intuitive. Basic save, exit, print functions that are used in common, have different non-intuitive keys. This leads to a laborious electronic record process that doesn’t work across different systems. Doctors and nurses that work in different systems, which is true for all private practitioners and part-time nurses, are frequently confused and make errors, the very thing that electronic medical records were touted to prevent.

Thus it may be far better for most private practitioners and small groups to be content with a digital record that serves the group well and has easy access across several offices, for retrieval of partner’s entries that can also expand as new developments appear. There are small programs for prescriptions, ordering tests, retrieving test, sending them out to the patient that fit very well with any digital system that a physician or small group already uses.

Don’t be hoodwinked by politicians’ lack of understanding of EMRs.
EMRs are not state of the art at this time or in the near future for small practices.

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9.         The Health Plan for the USA: Planning the Patient-Centered Health Plan for America

There are a large variety of health plans in the United States and throughout the world. In none of these is the patient the primary focus. The plans are focused on the insurance control of the patient by the physician under the illusion of controlling costs; they are focused on government control of patient care by the physician also under the illusion of controlling costs; they are focused on Hospital Foundation control of patients by their physician under the illusion of controlling costs. However none have controlled costs. They all then blame the physician’s pen. None have utilized the truly effective way to control what physicians order without increasing costs through oversight, primarily by a team of nurses paid by the insurance company, Medicare or MediCal, or the hospital and their foundations.

The insurance industry has obtained control of patients through control of physicians and their practices. Nearly every major test, procedure, consultation, and hospitalization has to be approved by the insurance carrier. As Jerry Smedinghoff, an actuary, says in his addresses, this just adds MUDDA to the system, a Japanese term of placing obstacles in the path which decreases efficiency and increases cost, not the other way around as is generally presented. Physician time in plotting a course around these Blocks to Health Care is considered not being a cost—in other words a donation “to the cause.” And this plotting a path around the obstacle is another administrative challenge—how to block the detour. In fact, the various components of the health care team no longer cooperate in helping patients get well—they are essentially at war with each other—friendly as generally observed by outsiders. But in fact, it can be rather vicious.

One insurance executive from a major health carrier once remarked privately at the reception after his speech, “We could probably save money if we just paid physicians the prevailing fees and fire the ‘oversight’ staff. But why would we want to give up our control of physicians?”

This can best be illustrated in the unpopular concept of Concierge Practice. Concierge practices allow the patient to determine the time they spend with their physician. This has been estimated at four to eight times as much physician time for which they pay. However, studies have shown that patients in a concierge practice visit ERs 65% less, see consultant physicians 50% less, be hospitalized 25% less and have 35% few hospital days and consume 50% less prescription drugs. These latter are very costly medical services compared to concierge primary care. Thus the miner costs of having a concierge physician is proven to be many times offset by the savings at the secondary and more costly level. Access is increased and costs are decreased.

This can also be illustrated by adding a co-payment to all services. This works only if the co-payment is a percentage of the charge, not only of the professional visit, but also of each test the physician orders. Thus, the greater the cost of a test or service the patient desires, the greater is the cost to him. It the co-payment of outpatient testing is 30%, then the patient will be motivated to be most cost efficient. A common request is an MRI of a joint or back without a conventional x-ray at one-fifth the cost to see if there is any abnormality. It the co-payment is $60 for the basic $200 x-ray and $180 for the $600 MRI, most patients would choose, under the percentage co-payment plans, to have the screening x-ray first and then re-discuss the matter two weeks later when the results are back and the patient may have resolved his pain with routine analgesics.

In either case it is the patient’s involvement with the costs vs benefits that reduced the health care costs. This is the way it should be.

The best health plan for the USA would be patient oriented, centered, and directed with the doctor at the patient’s side.

This column, HealthPlan for the USA, will be continued in each HPUSA newsletter for a complete picture of what health care reform should look like.

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

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

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

· Americans for Tax Reform,, Grover Norquist, President, keeps us apprised of the Cost of Government Day® Report, Calendar Year 2010. Cost of Government Day (COGD) is the date of the calendar year on which the average American worker has earned enough gross income to pay off his or her share of spending and regulatory burdens imposed by government on the federal, state and local levels. Cost of Government Day for 2009 was August 12, a seven-day increase above last year's revised date of August 19. With August 19 as the COGD, working people must toil on average 231 days out of the year just to meet all the costs imposed by government. In other words, the cost of government consumes 63 percent of national income. If we were to put health care into the public trough, the additional 18 percent would allow the government to control 80 percent or nearly three-fourths of our productivity and destroy our health care in the process. We would have almost no discretionary income.

· National Taxpayer's Union,, Duane Parde, President, keeps us apprised of all the taxation challenges our elected officials are trying to foist on us throughout the United States. To find the organization in your state that's trying to keep sanity in our taxation system, click on your state at On August 20 last year, you started working for yourself. It takes nearly 8 months of hard work for every American to pay for the cost of government. Read more  . . .

· Citizens Against Government Waste,, America’s Taxpayer’s Watch Dog.

Since 1984, Citizens Against Government Waste has been the resource that policymakers, media, and the taxpaying public rely on for the bottom line behind today's headlines. Waste News is the first stop for reporters covering government spending. Members of the Media visit our media page to sign up for email updatesor to set up interviews with CAGW policy experts.

Porker of the Month will introduce you to some of government's worst pork-barrel offenders.

"To advocate an efficient, sound, honest government is neither left-wing nor right-wing, it is just plain right."–J . Peter Grace, CAGW Co-Founder

· Evolving Excellence—Lean Enterprise Leadership. Kevin Meyer, CEO of Superfactory, (Sorry about the nepotism, but his message is important) has started a newsletter that impacts health care in many aspects. Join his evolving excellence blog . . .  Excellence is every physician’s middle name and thus a natural affiliation for all of us. This month read The Customer is the Boss at FAVI “I came in the day after I became CEO, and gathered the people. I told them tomorrow when you come to work, you do not work for me or for a boss. You work for your customer. I don’t pay you. They do. . . . You do what is needed for the customer.” And with that single stroke, he eliminated the central control: personnel, product development, purchasing…all gone. Looks like something we should import into our hospitals. I believe every RN, given the opportunity, could manage her ward of patients or customers in similar lean and efficient fashion.

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

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

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Articles that appear in HPUSA may not reflect the opinion of the editorial staff. Several sections are entirely attributable quotes in the interest of the health care debate. We trust our valuable and faithful readers understand the need to open the debate to alternate points of view to give perspective to the freedom in healthcare issues. We have requested permission and many of the sites have given us standing permission to quote extensively from their sites and refer our readers back to their site. Editorial comments are in brackets.

PLEASE NOTE: HealthPlanUSA receives no government, foundation, or tax favored 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 (and Friends of Freedom), while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country. Contributions are welcomed but are not tax deductible since we ask for no federal tax favors. Please see your tax advisers to see if contributions may be a business deduction for you.

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Del Meyer, MD, CEO & Founder

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

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Words of Wisdom

The more the state “plans” the more difficult planning becomes for the individual. –The Road to Serfdom 1944

We have progressively abandoned that freedom in economic affairs without which personal and political freedom has never existed in the past. –Friedrich August von Hayek in The Road to Serfdom.

Liberty not only means that the individual has both the opportunity and the burden of choice; it also means that he must bear the consequences of his actions and will receive praise or blame for them. Liberty and responsibility are inseparable. A free society will not function or maintain itself unless its members regard it as right that each individual occupy the position that results from his action and accept it as due to his own actions. –Friedrich August von Hayek in The Road to Serfdom.

Some Recent Postings

In The October HPUSA Issue:       

1.             Featured Article: The Forgotten Man of Socialized Medicine

2.             In the News: Discontinuing Failed Drug Research is Expensive

3.             International Healthcare: The Stockholm Network

4.             Government Healthcare: A Growth Agenda for the New Congress

5.             Lean HealthCare: Healthcare is going ‘lean'

6.             Misdirection in Healthcare: What Motivated ObamaCare?

7.             Overheard on Capital Hill: Benign Dictatorship and the Progressive Mind.

8.             Innovations in Healthcare: Health Plan from the National Center for Policy Analysis  

9.             The Health Plan for the USA: How technology reduces health care costs

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

New Years Day in History, the Day of Hope and Good Intentions

President Lincoln issued Emancipation Proclamation in 1863.

First issue of the Liberator, William Lloyd Garrison’s antislavery periodical 1831

26 Nations signed United Nations Declaration in World War II in Washington, D.C. in 1942

Birthday of Paul Revere, 1735; Betsy Ross, 1752; General Anthony Wayne, 1745

Brooklyn merged with New York in a single city in 1898

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

Thus we must also remember that ObamaCare has nothing to do with appropriate healthcare; it was similarly projected to gain loyalty by making American citizens dependent on the government and eliminating their choice and chance in improving their welfare or quality of healthcare. Socialists know that once people are enslaved, freedom seems too risky to pursue.