1. Featured Article: Why the Resurgence of Socialized Medicine When It's Failing Globally?
2. In the News: Do We Need Another 50 Million Cops to Police Every Family?
3. International Medicine: NHS Goal to Cut Waiting Time to Four Months? WOW!
Why is there renewed emphasis on socialized medicine when it's failing in all industrialized countries throughout the world? Dr. & Mrs. Friedman's explanation helps us understand this contradictory phenomenon.
The aim of this brief essay is to present a hypothesis that a major change in social and economic policy is preceded by a shift in the climate of intellectual opinion. The intellectual tide is spread to the public by all manner of intellectual retailers: teachers and preachers, journalists in print and on television, pundits and politicians.
There are powerful tides in the affairs of men, interpreted as the collective entity we call society, just as in the affairs of individuals. The tides in the affairs of society are slow to become apparent, as one tide begins to overrun its predecessor. Each tide lasts a long time -- decades, not hours -- once it begins to flood and leaves its mark on its successor even after it recedes. In almost every tide a crisis can be identified as the catalyst for a major change in the direction of policy.
The first tide we will examine begins in 18th-century Scotland with a reaction against mercantilism expressed in the writings of David Hume, Adam Smith's Theory of Moral Sentiments (1759), and above all The Wealth of Nations (1776). On the other side of the Atlantic 1776 also saw the proclamation of the Declaration of Independence, in many ways the political twin of Smith's economics. Smith's work quickly became common currency to the Founding Fathers. By the early 19th century the ideas of laissez faire, of the operation of the invisible hand, of the undesirability of government intervention into economic matters, had swept first the intellectual world and then public policy. Reinforced by pressures arising out of the Industrial Revolution, these ideas were beginning to affect public policy. To read more, please go to www.medicaltuesday.net/index.asp.
The repeal of the mercantilist Corn Laws in Britain in 1846 is generally regarded as the final triumph of Adam Smith after a 70-year delay. In fact some reductions in trade barriers had started much earlier, and many nonagricultural items continued to be protected by tariffs until 1874. So it took nearly a century for the completing of one response to Adam Smith.
The other countries of Europe and the United States did not follow the British lead by establishing complete free trade in goods. However during most of the 19th century, U.S. duties on imports were primarily for revenue (not protection). Except for a few years after the War of 1812, customs provided between 90 and 100% of total Federal revenues up to the Civil War. And except for a few years during and after the Civil War, customs provided half or more of Federal revenues until the Spanish- American War at the end of the century. Nontariff barriers such as quotas were nonexistent. Movement of people and capital was hardly impeded at all.
In the triumphant ideas of Adam Smith offered both an explanation and an obvious alternative option; tariffs aside, near complete laissez faire and nonintervention reigned into the next century.
Measuring the role of government in the economy is not easy. One readily available, though admittedly imperfect, measure is the ratio of government spending to national income. At the height of laissez faire, peacetime government spending was less than 10% of national income in both the United States and Great Britain. Federal spending was generally less than 3% of national income, with half of that for the military.
On the broader scale the tide that swept the 19th century brought greater political as well as economic freedom. Despite occasional financial panics and crises, Britain and the United States experienced remarkable economic growth. The United States in particular became a Mecca for the poor of all lands. This was a result of the increasing adoption of laissez faire as the guiding principle of government policy.
This remarkable progress did not prevent the intellectual tide from turning away from individualism and toward collectivism. How can we explain this shift in the intellectual tide when the growing pains of laissez-faire policies had long been overcome and impressive positive gains had been achieved?
Two effects of the success of laissez faire fostered a reaction.
• First, success made residual evils stand out all the more sharply, both encouraging reformers to press for governmental solutions and making the public more sympathetic to their appeals.
• Second, it became more reasonable to anticipate that government would be effective in attacking the residual evils. A severely limited government has few favors to give. Hence there is little incentive to corrupt government officials, and government service has few attractions for people intent on personal enrichment.
Government was engaged primarily in enforcing laws against murder, theft, and the like and in providing municipal services such as local police and fire protection -- activities that engendered almost unanimous citizen support. Britain, which went furthest toward complete laissez faire, became legendary in the late 19th and early 20th centuries for its incorruptible civil service and law-abiding citizenry -- precisely the reverse of its reputation a century earlier.
But by 1900, the doctrine of laissez faire had more or less lost its hold upon the English people. In the United States the development was similar, though somewhat delayed. As late as 1929 Federal spending amounted to only 3.2% of the national income; one-half of this was spent on the military plus interest on the public debt. Spending by federal, state, and local governments on what today is described as income support, Social Security, and welfare totaled less than 1% of national income.
The world of ideas, however, was different. By 1929 socialism became the dominant ideology on the nation's campuses. The New Republic and The Nation were the intellectuals' favorite journals and [the socialist] Norman Thomas their political hero. The critical catalyst for a major change was, of course, the Great Depression, which shattered the public's confidence in private enterprise, leading it to regard government involvement as the only effective recourse in time of trouble and to treat government as a potential benefactor rather than simply a policeman and umpire. The effect was dramatic. By the 1980s federal government spending grew to 30%, and total government spending was over 40% of national income. But spending alone cannot illustrate the role government came to play. Many intrusions into people's lives involve little or no spending: tariffs and quotas, price and wage controls, ceilings on interest rates, local ceilings on rents, zoning regulations, building codes, and so on.
Throughout the ascendancy of socialist ideas there had, of course, been counter-currents -- kept alive by Friedrich Hayek and some of his colleagues in Britain; by Ludwig von Mises and his disciples in Austria; and by Albert Jay Nock, H. L. Mencken, and others in the United States.
Hayek's Road to Serfdom in 1944 was probably the first real inroad in the dominant intellectual view. Yet, at first, the impact of the free market on the dominant tide of intellectual opinion was minute. Even for those of us who were actively promoting free markets in the 1950s and 1960s it is difficult to recall how strong and pervasive was the intellectual climate of the times.
The tale of two books by the present authors, both directed at the general public and both promoting the same policies, provides striking evidence of the change in the climate of opinion. The first, Capitalism and Freedom, published in 1962 and destined to sell more than 400,000 copies in the next eighteen years, was not reviewed at the time in a single popular American periodical. The second, Free to Choose, published in 1980, was reviewed by every major publication and became the year's best-selling nonfiction book in the United States with worldwide attention.
Further evidence of the change in the intellectual climate is the proliferation of think tanks promoting the ideas of limited government and reliance on free markets.
The same contrast is true of publications. FEE's Freeman was the only one we can think of that was promoting the ideas of freedom 30 to 40 years ago. Today numerous publications promote these ideas, though with great differences in specific areas: The Freeman, National Review, Human Events, The American Spectator, Policy Review, and Reason. Even the New Republic and The Nation are no longer the undeviating proponents of socialist orthodoxy that they were three decades ago. . .
Two new pairs of tides are now in their rising phases: in public opinion, toward renewed reliance on markets and more limited government. If the completed tides are any guide, the current wave in opinion is approaching middle age and in public policy is still in its infancy. Both are therefore still rising and the flood stage, certainly in affairs, is yet to come.
For those who believe in a free society and a narrowly limited role for government, that is reason for optimism, but it is not a reason for complacency. Nothing is inevitable about the course of history -- however it may appear in retrospect. Because we live in a largely free society, we tend to forget how limited is the span of time and the part of the globe for which there has ever been anything like political freedom: the typical state of mankind is tyranny, servitude, and misery.
Once a tide in opinion or in affairs is strongly set, it tends to overwhelm counter-currents and to keep going for a long time in the same direction. The tides are capable of ignoring geography, political labels, and other hindrances to their continuance.
Yet it is also worth recalling that their very success tends to create conditions that may ultimately reverse them. The encouraging tide in affairs that is in its infancy can be still overwhelmed by a renewed tide of collectivism. The expanded role of government even in Western societies that pride themselves in being part of the free world has created many vested interests that will strongly resist the loss of privileges that they have come to regard as their right.
Milton Friedman, one of the 20th century's most eloquent spokesmen for liberty, died on November 16, 2006. His long and successful life was a celebration of the American Dream. Born in 1912 to poor Jewish immigrants in New York City, Friedman received the best education America could offer: a B.A. from Rutgers University, an M.A. from the University of Chicago, and a Ph.D. from Columbia University. In 1976 Milton Friedman won the Nobel Prize in Economics.
As a young economist, fresh from his Ph.D. studies at Columbia, Milton Friedman and George Stigler (a future fellow Nobel laureate) co-wrote one of FEE's first monographs, Roofs or Ceilings? Widely regarded as the leader of the Chicago school of monetary economics, Friedman was senior research fellow at the Hoover Institution and Paul Snowden Russell Distinguished Service Professor of Economics, Emeritus, at the University of Chicago. He was awarded the Presidential Medal of Freedom in 1988 and received the National Medal of Science the same year. Milton Friedman and Rose D. Friedman were co-authors of Capitalism and Freedom, Free to Choose, and their memoirs, Two Lucky People.
Adapted from an article that appeared in the April 1989 issue of The Freeman.
©2005 Foundation for Economic Education. All Rights Reserved.
To read the entire article, go to www.fee.org/publications/notes/notes/theTide.asp.
PALO ALTO, Calif. -- California Assemblywoman Sally Lieber is going to introduce a bill to make it a misdemeanor to spank children who are four years of age or younger. Violators will be subject to a year in jail and/or a $1,000 fine. . .
I recently had the chance to chat with Ms. Lieber on NPR about her proposed legislation. She is intelligent, fluent and has excellent sound bites. She defends her bill by saying that we need a law against child beating. But California Penal Code section 11166 already prohibits child abuse (beating etc.) and makes it a crime for doctors, teachers and others in charge of children not to report suspected abuse to the government child protection agencies. The police must also report and, like CPAs, investigate the reports. Those convicted of child abuse are punished quite severely.
Ms. Lieber justifies her proposal by saying at the very least it will provoke a "dialogue." It has. The telegenic assemblywoman has appeared on national TV and comes across as bright and caring, which doesn't harm her political future. She deftly substitutes the word "beating" for the vaguer term "spanking," putting her opponents in the uncomfortable position of sounding indifferent to the terrible cases of child abuse that we often see on TV.
However, even in a politically liberal state like California, antispanking legislation has produced a backlash against government interference with the traditional right and duty of parents to decide how best to raise their children. To read more, please go to www.medicaltuesday.net/news.asp.
Ms. Lieber also accurately remarks that decades ago, the male-dominated police and judiciary ranks needed to be prodded by women's advocates to arrest in domestic violence cases. However, assault and batteries were already crimes. This new bill will create thousands of new crimes in California whose criminal justice agencies are already in a state of crisis.
Police throughout the state are unable to fill their ranks at a time when they are saddled with preventing terrorism, eliminating gang violence, stopping an upswing in random shootings, an increase in homicides, preventing drug use, putting an end to graffiti, controlling traffic, devoting an increasing share of resources to investigating complaints against officers and myriad other problems. The courts are swamped by the volume of cases; the Supreme Court has declared California's sentencing to be unconstitutional; the California prison system has been placed under receivership by federal judges for overcrowding and prisoner abuse. Increases in California's criminal justice costs have been out of control for decades. The state's budget deficit, which threatens solvency, has to a large extent been the result of runaway criminal justice costs. This could well worsen the crime picture in the Golden State.
Spanking legislation will also have unforeseen consequences. As Arnold Schwarzenegger remarked, "How do you enforce that?" One can't expect children four and under to call 911 to turn in their parents for spanking.
Just as important is the impact that such legislation will have on families and the children it is intended to protect. Confused parents may fail to provide necessary discipline for children to keep them from running into traffic, playing with matches, falling into swimming pools or engaging in other hazardous activities. Dragging parents into courts, putting them in jail or fining them may do far more harm to the child than an occasional swat on the rear end. . .
If someday Ms. Lieber and her husband David experience the joy of bringing up children, they will also experience the constant concern that parents have for their offspring's safety. It is a lot harder to believe that parents are fools or brutal criminals who must be controlled by unrealistic laws when you are a parent exercising your best judgment every day on how to keep your children safe.
Mr. McNamara is a research fellow at the Hoover Institution at Stanford.
To read the entire article, go to http://online.wsj.com/article_print/SB116986743854889878.html.
3. International Medicine: A NHS Goal to Cut Waiting Time to Four Months? WOW! What a Way to Die -- on a Waiting List.
Tony Blair yesterday stepped up the drive to define his legacy by declaring that he wanted to see "the framework" in place to ensure that by the end of 2008 no one waits more than 18 weeks for an operation after seeing the GP. . .
It would mean that over the course of a decade "what was the biggest problem in the National Health Service - that people had to wait months and months, often in pain and sometimes even dying for want of their operations" - would have been "transformed", the prime minister said. . .
Some hospitals are considering keeping operating theatres open in the evenings and at weekends. But the NHS Confederation, which represents health authorities and trusts, said many hospitals would have "to completely redesign how patients flow through the system" to achieve the goal. To read more, please go to www.medicaltuesday.net/intlnews.asp.
James Johnson, chairman of council of the British Medical Association, said there were two "stumbling blocks" to using operating theatres more intensively. One was how to staff them.
But the other was that "many parts of the NHS are broke. If primary care trusts have run out of money, they clearly cannot buy a lot more operations. This and the lack of staff have already prevented extended working from happening in many parts of the NHS."
His comments came as the health department is expected to announce today that, three-quarters of the way through the financial year, the NHS finally looks on track to break even once a big contingency reserve created earlier in the year by top-slicing primary care trust allocations is taken into account.
That has been achieved, however, by some primary care trusts delaying operations into the next financial year, or putting a minimum wait on treatment, while, according to suppliers, some parts of the NHS are paying bills late or cutting orders for supplies until the financial year ends in March. . .
The figures emerged as a doctors.net poll of more than 3,000 doctors for The Times showed that almost three-quarters believe that the extra money for the NHS has not been spent well. Some 28 per cent believe David Cameron would protect the NHS more effectively than would Gordon Brown, who is favoured by just 15 per cent.
To read the entire article, go to www.ft.com/cms/s/19ec376e-c089-11db-995a-000b5df10621.html.
Gov. Arnold Schwarzenegger wants all Californians to have medical insurance. So he's going to force them to have it.
Schwarzenegger abandoned his opposition to mandated employer-based health insurance and embraced the idea as his own. "Everyone in California must have insurance. If you can't afford it, the state will help you buy it, but you must be insured," Schwarzenegger said last month.
Of course, his "solution" won't solve the problem. By making medical care look cheap to people, expanded insurance will push prices up even faster. Everyone will end up paying more. But politicians benefit because the costs will be hidden.
The governor also wants to enlarge the state's coverage for children by including people with incomes as high as $60,000 for a family of four. Imagine that: You can make $60,000 a year and put your kids on the dole. To read more, please go to www.medicaltuesday.net/medicare.asp.
This ought to dispel any notion that Schwarzenegger is a believer in small government. Here he is following former Republican Massachusetts Gov. Mitt Romney down the path of state socialized medicine. Romney said compulsory insurance would cost a person $2,400 a year. But now we know it's at least $4,560. . .
The root of the problem is that few people face the true cost of medical care. Medicare and Medicaid beneficiaries don't because taxpayers pay their bills. People with employer-based medical insurance don't because insurance policies shield them from it. Since they pay only small co-pays when they see a doctor, they don't ask, "Do I really need that test?" but rather, "Does my insurance cover it?"
People who don't face the full cost of their choices don't act like cost-conscious consumers. Higher prices result.
With a rational government policy, people would save money for routine medical care and buy insurance for solvency-threatening illness. After all, we don't buy auto insurance to pay for oil changes and worn-out windshield-wiper blades. But today, people expect medical insurance to cover routine physical exams because someone else seems to pay the premiums.
All this hurts people who buy their own insurance or don't have it. It would be good if they could buy a basic high-deductible catastrophic policy. For a healthy young person, such a policy would be relatively cheap. But because of special-interest lobbying, most states mandate that insurance cover things that most people would never buy if they were paying the cost openly -- things like Viagra and substance-abuse counseling. The Council for Affordable Health Insurance (CAHI) reports that states have imposed 1,824 mandates on insurance companies. This makes even a high-deductible policy absurdly expensive in many states. . .
The upshot is that, however well intentioned, government regulation of medicine and insurance brings us mostly headaches, and Gov. Schwarzenegger's plan will bring Californians even more. But that should be between him and them. They should have the right to fail. . .
Let the states experiment! Universal coverage is a feel-good idea that many people want Washington to impose. Better to have models of failure in individual states so we all don't have to suffer! We need living reminders of collectivism's faults. . . .
The feds should let us learn.
To read the entire article, please go to http://www.realclearpolitics.com/printpage/?url=http://www.realclearpolitics.com/articles/2007/02/schwarzeneggers_folly.html.
Severe infections are an increasing problem despite the golden age of antibiotics. We've had two patients with presumed spider bites that had serious cellulitis requiring intravenous antibiotics for an extended period of time. Since no one can stay in the hospital at $2500 a day just for antibiotics, this is frequently given at home by a hospital-based home health-care service. Everyone simply assumed it was more cost-effective for a nurse to spend an hour with a patient on a home visit administering an antibiotic than to pay the high rent of a hospital.
I recall when I made home visits to a patient on life support; my home visit charge of $125 was reduced to about $80 by Medicare. The patient then showed me a Medicare receipt that revealed the hospital charged $165 for the nurse visit and was paid the full amount by the government. I was writing the nursing orders; however, the nurse carrying out my orders got paid more than twice as much than I did while supervising the case. One of my associates in a similar situation complained and Medicare stated that the hospital not only had to provide the RN, but also the car and the mileage. When my associate pointed out to Medicare that he also had to provide a car and pay for the mileage, the letter went unanswered. To read more, please go to www.medicaltuesday.net/gluttony.asp.
Why would any physician ever trust Medicare or the government to be fair?
In the Medical Staff Lounge last week (see Overheard in the Medical Staff Lounge below), one of my colleagues had a family member go home from the hospital on IV antibiotics for four weeks, as recommended by the Infectious Disease Consultant. The Hospital Home Health-Care Service would provide the service and it would cost $2500 per injection for the four weeks or about $70,000. The hospital would also provide the second antibiotic for $500 a day or about $14,000 for the four weeks. My colleague was so incensed that he called the drug company and found out that the drugs were now generic. He called his pharmacist friend and found that it could be delivered the next day. He found another company to provide service. The $2500 per injection per day became $250 per week and the $500 per day became $50 per week. The weekly charge on the open market was 1/10th the hospital daily charge approved by the government in both cases. This calculates to a total cost for the four weeks at 1/70th the government allowable.
Does anyone really believe that the hospital didn't buy generic and charge proprietary prices? Does anyone really believe that hospitals are not trying to control health care costs?
We are running out of private businesses, including hospitals, which believe in the free marketplace. Why should they when they can gouge the public with the blessings of Medicare and the government and make 70 times as much by hiding costs? Is there anyone in Congress that understands this travesty of justice (or just plain dishonesty)?
The open and free marketplace is the greatest reducer of health care costs.
Hospital Cost Transparency would immediately allow market forces to reduce costs.
Has anyone noticed this approach is not working? Today, most doctors do not know much about nutrition or weight loss other than that we should encourage it. The public is bombarded by companies selling useless and expensive gimmicks that only shrink the pocketbook, not the stomach. Advertising for foods and lifestyles that promote obesity is everywhere. . .
Unfortunately, the U.S. government is not very good at implementing aggressive, comprehensive interventions to address major social problems. There is no question that preventing obesity is far more effective than treating it. Pills and surgery are just not the answer for society. But prevention requires diverse groups, who may not always have the same agenda, to work together. It will require the government to admit it has a responsibility to help and create programs that do not require great effort by the public, with built-in incentives for businesses, schools and individuals to do the right thing. It will require mandatory actions because voluntary actions are not working.
To read Dr. Wilkes recommendations for treating obesity, from warning labels, advertising bans, taxes on junk foods, requiring health insurance companies to get more involved in practicing medicine, policing vending machines, tax incentives for company fitness programs, requiring bike lanes, etc, et al, please go to www.sacbee.com/296/v-print/story/124214.html.
For a professor and teacher of medical students to castigate his profession for not knowing how to treat obesity may be more a reflection on the teacher than on the profession. To further defer this obligation to the incompetent government is indeed unfortunate.
Government involvement will always increase costs, reduce benefits and create discord among us.
Dr. Dave: (who had just grabbed his lunch and sat down at our table but was almost too emotional to talk) My mother had a severe infection and was just discharged from the hospital to receive home-based antibiotics for four weeks. (See Medical Gluttony above for details.) I saved Medicare Part D a bunch of money by doing the legwork to find generic antibiotics at 1/70th the cost.
Dr. Michelle: Why would you do that?
Dr. Sam: Yes, you just caused the hospital to lose nearly a $100,000. You better look behind you wherever you go!
Dr. Dave: You've got to be kidding. Won't I be Medicare's friend?
Dr. Rosen: Medicare and the hospitals are both villains. The hospitals have enough half-time salaried doctors in most departments now that they can do just about anything they want. To read more, please go to www.medicaltuesday.net/lounge.asp.
Dr. Dave: How do you figure?
Dr. Rosen: These half-time department chiefs who may make $90,000 a year from the hospital and are also in practice in their private offices the other half-time can't offend the hospital. Whose signature do you think is on those $90,000 worth of checks? They don't want to risk losing that freebie.
Dr. Sam: Yes, Dave, the administrator can just order the chief of your department to review all your charts and send all question marks to the Peer Review Committee. He doesn't have to say another word.
Dr. Dave: My records are all up to par. They won't find anything wrong.
Dr. Sam: Don't be so naïve, Dave. All of us make insignificant mistakes every day on every patient we see that someone can take issue with. In fact, many may not be mistakes at all but just normal professional variations. But what we do is seen by the public as so important that doctors can't make errors and a therapeutic variation will be seen by the public as a serious life-threatening mistake. They will always side with the hospitals that they see as angels of Mercy.
Dr. Rosen: Almost once a week, I have nurses bring some medication error to my attention which may be a simple dosage variation of no consequence or if significant, can be straightened out by varying or omitting the next dose. The question I'm always asked is do I want an incident report filed? I always say no because these are normal expected clinical human errors of no consequence. The last thing I want to do is get the hospital attorneys, who review all such reports, involved in laying down another layer of bureaucratic control that will then produce far more errors and increase health-care costs unnecessarily.
Dr. Sam: Dave you must have noticed that every year we have a doctor or two that leaves the staff in disgrace having done nothing egregious except riled some competing physician or cause the hospital to lose money. As one administrator told me, "Isn't getting the money in the name of the game?"
Dr. Rosen: I once had a competitor pull every procedure I did over a two-year period. When I saw them in a Peer Review file, I went straight to the staff secretary and she blanched. She said it was all a mistake. She immediately took them all out. She avoided me for the next six months or so. But I monitored the file.
Dr. Sam: So you see, Dave, someone went pfishing in Dr. Rosen's records to find errors and got caught. Otherwise Dr. Rosen might be facing a hospital prosecutor and lose his privileges, perhaps his license and be reported to the National Data Center, the tomb for physicians who will never have another chance to practice or support their families or send their children to college or ever retire except to a prison cell.
Dr. Yancy: That's why we need to eliminate hospitals from employing physicians who then turn on us and become traitors.
In San Francisco Medicine the Official Publication of the San Francisco Medical Society, Stephen Askin, MD, discusses Health Savings Accounts The Wave of the Future?
. . . A health savings account (HSA) is a relatively new system for financing health care. It has two essential elements: a high deductible health insurance policy and a savings account paid for by tax-deferred dollars. The minimal deductible is $1,000 for an individual and $2,000 for a family; the maximums are $2,700 and $5,450, respectively. This type of policy is significantly cheaper than a low-deductible policy and is therefore an appealing option for some people. The trustee for the account may be the insurance company, a bank, or a PPO, and the annual contribution is usually close to the amount of the deductible. The money in the account may be invested in an appropriate manner and is to be spent for health care. If used for nonmedical purposes, tax must be paid, as well as a 10 percent penalty. When the insured turns sixty-five, the money can be withdrawn tax-free. When the deductible has been met, the insurance is available for serious and expensive illnesses, thus serving as catastrophic insurance. The HSA embodies our "ownership society" in the health care sector, which reflects a philosophical shift in emphasis from collective to individual responsibility for the management and financing of care. To read more, please go to www.medicaltuesday.net/voicesofmedicine.asp.
The concept of HSAs, or medical savings accounts (MSAs), as they were initially called, was first discussed by the AMA and others in the 1980s. Then in 1996, as part of HIPAA legislation, the law enabled formation of MSAs on a trial basis. They were to be used only for individuals or businesses with fifty or fewer employees, and a maximum of 750,000 plans were permitted nationwide. Congress originally allowed the plans to operate on a four-year trial basis and then planned to reconsider them. There was considerable political opposition to the MSAs from HMOs and others who were not interested in competition, as well as those advocating a national health plan. By 1999, only about 100,000 plans were operating, and in 2000 the trials were extended for an additional two years.
In 2003, new legislation -- part of the Medicare Improvement Act -- gave MSAs a new name, Health Saving Accounts (HSAs) and removed many of their restrictions. There was no sunset, the number of plans was unlimited, and the fine for nonmedical use was reduced from $150 to $100. The MSA permitted either the employer or the employee to contribute; the HSAs permitted a sharing of the funding. HSAs seemed to gain popularity. . .
An HSA plan improves access to health care funding, even for those in below average economic brackets. For starters, the insurance is relatively cheap. Employers may help fund the savings account. If there is a temporary stoppage of income, contributions can be deferred, making up the funds at the time of a bonus or unexpected income. The HSA is portable, allowing patients to change jobs without losing health coverage. According to the General Accounting Office, 40 percent of people signing up in the MSA pilot project were previously uninsured, showing its appeal to many in this group.
HSA plans expand consumer choice and control. There is no limitation on specialists, labs, hospitals, drugs, etc., as long as the consumer hasn't met the deductible. HSA plans also increase savings. Most people will not spend all the funds in the account but will let them accumulate tax free, with dividends and interest leading to a nice nest egg available at age sixty-five, when the money can be withdrawn without tax or penalty.
What does the future hold for HSAs? According to an estimate by Diamond Cluster International, a management consulting firm, by 2010 more than 15 million Americans, or about 10 percent of all insured, will have a health savings account. And according to a New York Times article dated January 27, 2006, Wall Street groups -- including banks and money managers -- are positioning themselves to become central players in the business of health care by offering to manage HSAs. Maybe HSAs fill a need for a category of patients that currently has no other appealing options?
Read the entire article from San Francisco Medicine at www.sfms.org//AM/Template.cfm?Section=Home.
The other day at the nursing station, I observed the ward clerk reading "Weight Watchers" as she devoured a "Babe Ruth." I guess that keeps the scales balanced and the economy moving. It also contributes to the epidemic in America – 50-60% of the population is overweight with 25-33% affected with obesity. We consumed 15% more calories in 1994 than we did in 1970 and today we dine out twice as often. If obesity was an infectious disease, we would call it a national crisis.
Of all the books that cross my desk, there is at least one or two each month about dieting. The "diet industry" is flourishing. But is there really any new information? At one bookstore, I counted 107 different diet books. At another, there were over 200 titles. It is interesting that as this deluge of new books was filling up the shelves, some "dated" diet books that spoke of revolutionary new medical dietary evidence were now on sale at 10% of their initial listing.
There are number of diet books written by celebrities. These authors are obviously without credentials. However, some of these books are quite basic and meet a need because of a co-author with credentials, e.g., RD, MS, PhD or MD, although the latter group may not always be as knowledgeable as the public assumes.
A brief review of some of these books will describe this self-perpetuating industry. The questions still remain. Are they of value to the overweight Americans? Are they helpful to those with other dietary problems such as hyperlipidemia, coronary artery disease, peripheral vascular disease, hypertension or diabetes? Do they provide complete lifelong nutritional programs? Do they incorporate exercise and stress management? There are at least three that do. To read more, please go to www.medicaltuesday.net/bookreviews.asp.
The Pritikin Diet Programs of Nathan Pritikin have been continued by his son Robert, director of the Pritikin Longevity Center. The current volume, The New Pritikin Program by Robert Pritikin (Pocket Books, $7) is friendlier and more in tune with a lifetime commitment. The results of the first 893 people that participated in the 26-day Pritikin Longevity Center program was published in 1974 and provided a wealth of data that was evaluated by the Department of Biostatistics and Epidemiology at Loma Linda University. The results indicated that 83% of hypertensive people lowered their blood pressure to normal and left the program drug-free; 50% of adult-onset diabetics on insulin left the program free of insulin; 90% of diabetics on oral drugs left free of drugs; 62% of drug-taking angina patients left the center drug free; cholesterol and triglycerides were each lowered an average of 25%; overweight people lost an average of 13 pounds; of the 64 people who were recommended for bypass surgery, 80 % of them had not undergone surgery even five years later. I remember that when Nathan Pritikin presented his data to medical staffs in this community during the mid 1970s, he himself had severe coronary artery disease and was recommended for bypass surgery. He declined and developed this program instead, which reversed his own atherosclerosis. There now have been over 50,000 people treated at the Pritikin centers in the last 15 years. They feel that quick fixes simply don't work in the long run and one may even worsen the problem. One must address all the factors of health. There is nothing magical. This is truly a proven formula for lifelong success and health.
A couple of years ago, my RN-NP introduced me to The Zone Diet by Barry Sears, PhD. Since then, he has written additional volumes, including Mastering the Zone, which I received in the current package of audio tapes (Harper Audio, $25). Dr. Sears gives a very comprehensive nutritional program that is easily put into action. After a discussion of the ill effects of hyperinsulinism, he presents a system of balanced eating so one always remains "in the zone." If you're "in the zone" of normal insulin levels you should not have postprandial lethargy. The current presentation seems more complete than what I have encountered in the past. He also states that only in America can one go to a gym and find valet parking. He advises that one should park at the most remote regions of a parking lot and walk. He even suggests that we park our cars about 15 minutes from work to provide at least 15 minutes of exercise every morning and every evening. He sees no need to buy exercise equipment or join a gym or pay to exercise. As physicians, we have people run in place for a two minute exercise pulse in an eight foot exam room. Americans have a hard time thinking that anything happens unless they spend money. Much of the world feels we have too much of that. I found Sear's system very easy to follow and quite effective. I lost my doctor-ordered 30 pounds in six months.
Eating Well for Optimum Health by Andrew Weil, MD, (Knopf, $25) is a very comprehensive guide to food, diet, and nutrition. As a clinical professor of medicine at the University of Arizona, and director of the Program in Integrative Medicine, he speaks with authority and writes in textbook fashion. However, it is very readable. He presents the basic facts about human nutrition that allows us to make informed decisions about weight reduction. He gives us the pros and cons about a number of diets. He's seen fad diets come and go and then, sometimes, come again and go again. He gives pointers on how to read labels on food products. He provides menu plans, recipes, and guidance for eating at home or in restaurants. In accord with his previous volumes, he gives dietary advice for a host of common ailments. . .
To read more, please go to www.healthcarecom.net/bkrev_Health.htm#Diets.
Reading these diet books reminds me of a recent Classic Peanuts strip in which Charlie Brown tells Snoopy that he had just read about a new diet. You can eat all you want, but you can't swallow. After Snoopy throws the dog dish at Charlie Brown, he awakens from his concussion stating, "It's no fun being a waiter if you can't joke with the customers!" Obesity is not a laughing matter with obese patients. You better not try to joke with them. On the other hand, it's hard sometimes to be serious with them or even bring up the subject of their weight. But then, it is no wonder that people get confused reading diet books. The messages indeed can be confusing. I hope, however, this has been helpful. My thanks to all the publishers for having sent them.
10. Hippocrates & His Kin: The typical state of mankind is tyranny, servitude and misery.
Friedman gives physicians a wake up call before we lose our profession to servitude.
Dilbert is working on a unique totally affordable health plan: The Google Do-it-yourself Plan. Just give Google your symptoms. They will lead you through a self-exam, feed in your findings, and Google will make recommendations for the right confirmatory tests. Then find a nurse practitioner who will sign the lab requisitions and your prescriptions.
With 95% of health care being non-surgical, your costs should be less than $100 a disease.
Sixty-nine-year-old-Ruby came in for her annual pulmonary evaluation. Among other complaints, she was putting on weight. Her exam confirmed a 20-pound weight gain since her last evaluation. Ruby stated that the extra pounds were NOT from the food she was eating. "In fact," she said, "I have to eat 5 or 6 times a day because otherwise I wouldn't get enough."
"You may be able to walk and chew gum at the same time, but soon you may not be allowed to walk and listen to your iPod while crossing a street in major New York cities. That's because Sen. Carl Kruger (D-Brooklyn) plans to introduce legislation that would ban people from listening to music players or using electronic devices that would hamper their awareness of their surroundings while crossing the street, said Jason Joppel, Kruger's chief of staff. The legislation would also apply to pedestrians using iPods and other MP3 players, BlackBerries, cell phones or other devices."
It may be safer to quit working, go on welfare, be a couch potato and watch the idiot box.
To read more on the moral consequences of paternalism, please go to http://www.fee.org/publications/the-freeman/article.asp?aid=2552.
To read more medical vignettes, please go www.healthcarecom.net/hhk1999.htm.
· John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
· PATMOS EmergiClinic - www.emergiclinic.com - where Robert Berry, MD, an emergency physician and internist practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website.
· PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/. Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
· Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis" at www.northernurology.com/articles/healthcarereform/administrativectomy.html.
To read the rest of this section, please go to www.medicaltuesday.net/org.asp.
· Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com.
· Dr. Elizabeth Vaughan is another Greensboro physician who has developed some fame for not accepting any insurance payments, including Medicare and Medicaid. She simply charges by the hour like other professionals do. Dr. Vaughan's web site is at www.VaughanMedical.com.
· David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.
· Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.
· Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.
To view some horror stories of atrocities against physicians and how organized medicine still treats his problem, please go to www.semmelweissociety.net.
· Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.
· Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week's column by Michael "the Rotweiller" Glueck, M.D is on The French Should Be More Like Dogs Than Frogs and can be read at www.newsmax.com/archives/articles/2007/2/20/124439.shtml.
· The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. . Be sure to scroll down on the left to departments and click on News of the Day in Perspective: Rationing of necessary services under "universal" care or go directly to www.aapsonline.org/nod/newsofday395.php. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read HILLARY CARE AGAIN? at www.aapsonline.org/newsletters/feb07.php. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief - www.jpands.org/. There are a number of important articles that can be accessed from the Table of Contents page of the current issue: www.jpands.org/jpands1104.htm. Don't miss the excellent articles on Fee Splitting by Ophthalmologists and Optometrist or the extensive book review section that covers ten great books this month.
The Marines' Memorial Association operates the Marines' Memorial Club in San Francisco. It is open to all servicemen and servicewomen, including former members of the Uniformed Services. We've been members for many years and enjoy staying in the 12-story Memorial Hotel and Museum on occasion, like we did last week. It's a pleasure to have dinner in the Leatherneck Steak House on the top floor overlooking a beautiful city, which Herb Caen called Baghdad by the Bay. On the eleventh floor is the Memorial Library which houses large multivolume histories of each of the uniform services, the two revolutionary wars, the two World Wars, and every war we've ever fought. There are also displays of centuries of Helmets and bullets from the Roman Empire to the War in Iraq. It contains the writings of George Washington and Winston Churchill. This library would provide a marvelous environment for a serious high school or college student writing a term paper or even a thesis.
This time, we stayed on the fifth floor, known as the Memorial Hall. There were 23 wall sections filled with plaques in the hallways between the rooms. The wall near our room had 84 plaques. A typical plaque read: Major Willard Crumback. In memoriam from your wife and your daughter.
On this date in 1902, John Steinbeck was born on Henry Wadsworth Longfellow's 95th birthday. Times had changed. Longfellow wrote of the distant past and contributed to American mythology. Steinbeck wrote of the present. His masterpiece, The Grapes of Wrath, told the story of the dispossessed Okies of the Depression and dust bowl era. It not only became a part of history; it helped to make history.
On this date in 1807, Henry Wadsworth Longfellow was born in Portland, Maine. He has given us the word picture images of Hiawatha, The Courtship of Miles Standish and Paul Revere's Ride.
On this date in 1933, the Nazis set fire to the Reichstag, Germany's fragile symbol of democracy, and announced it as a Communist plot to inflame the people against the Red threat and give dictatorial powers to Adolf Hitler. The world is a theatrical stage on which events are sometimes staged on a scale that boggles the mind.