Wednesday, May 28, 2008

What Physicians Have In Common and Can Agree On

A few weeks ago this post on received over 300 votes with an outstanding 95% of "yes" answers.

I see these few points as a declaration of independence of physicians and physicians should read and remember this from time to time.

"What we physicians all have in common"

1. We want to serve our patients, not insurance companies nor the government

2. We want to practice medicine independently according to our knowledge and judgment, and not be told what to do by insurance companies nor by the government

3. We want to make a living on our own, we do not want to be given what insurance companies and government deem "appropriate" for us

We want to be an independent, noble and free profession!

Because WE have the knowledge, the expertise and the skills, and the insurance companies and the government do NOT! "

Monday, May 26, 2008

Time to Nationalize the Educational System

The following statistics are from the National Institute for Literacy:

In the International Adult Literacy Survey (IALS) assessment, 1994-98:

The average composite literacy score of native-born adults in the U.S. was 284 (Level 3); the U.S. ranked 10th out of 17 high-income countries;
The average composite literacy score of foreign-born adults in the U.S. was 210 (Level 1); the U.S. ranked 16th out of 17 countries.

In the International Adult Literacy Survey (IALS) assessment, 1994-98:

The mean prose literacy scores of U.S. adults with primary or no education, ranked 14th out of 18 high-income countries;
The mean prose literacy scores of U.S. adults with some high school, but no diploma or GED, ranked 19th out of 19 high-income countries;
The mean prose literacy scores of U.S. adults with a high school diploma or GED (but no college), ranked 18th (tie) out of 19 countries;
The mean prose literacy scores of U.S. adults with 1-3 years of college, ranked 15th out of 19 countries; and
The mean prose literacy scores of U.S. adults with a bachelor's degree or higher, ranked 5th.

end of quote

These statistics show very clearly that we have a literacy crisis on our hands. I believe that literacy is a basic human right! The educational system needs to nationalized! Since we are underperforming the other industrialzied nations, the government needs to take over our education system - immediately!

But, uuuhooooh, wait, wait, the educational system is already nationalized! The government is already running it! So, how come we are not doing that well compared to other industrialized nations? How is this failure possible? I thought that "government run" is a recipe for complete and utter success!

Now, do you still think we ought to nationalize health care? Should we, really?

Sunday, May 25, 2008

Stupid Arguments in the Health Care Reform Debate

This particularly stupid argument about health care reform was repeated by Senator Clinton:
"Markets in Medicine do not work, you cannot shop for a physician when you are having a heart attack...."
Of course not, dear Senator, you are so right. But then, we knew that already.
Nobody expects such a thing. You shop when you are healthy. You compare family physicians in your neighborhood and maybe a little bit beyond. You use the internet with the new tools that bring together basic info about physicians such as training, board certification, specialty, practice profile that includes ages, most common diagnoses, and of course prices for the most common services.
Mind you, these websites do not exist yet in this comprehensive form, but they will come. In addition, you might have journals and magazine such as consumer reports in the future as well.

You shop before something happens, when you are looking for a family physician and then you rely on this family physician for your choice of hospitals and specialists.
Why do anti-free-market advocates pretend that this is not possible?

Let's consider this:
Can you shop for a lawyer while the robber is holding you at gun point?
NO! Uhoh, time to socialize lawyers! Senator Clinton as a lawyer should be intimately acquainted with shopping for lawyers in a free market.
Very strangley indeed - laywers seem to be completely exempt from any talk about "nationalized law care" because "we cannot shop for lawyers when a robber holds us at gunpoint".

Another argument from the single minded is that supposedly there is "not enough information about physicians". Since there is not enough information, we cannot shop and consequently we outgh to nationalize health care. Hello?

Well, there is even less information about lawyers, so, hurry up, let's nationalize lawyers too!
Make an experiment: Next time you see a politician (most of them are lawyers) during a speech, ask him or her to support a bill to nationalize the legal system, so that everybody, truly eerybody has "acccess to law" and so that there is no more "law only for the rich". Now watch how well that goes over! Take the arguments why a nationalized legal system is complete nonsense in the eye of the politician, and, voila! Apply that to medicine.

Medicine is very comparable with law, in the sense that the average person does not understand too much of it's intricacies and details and therefore most people tend to leave it to professionals to guide them. What works fro law, works for medicine.

So, fans of socialized medicine, go on, socialize law - everybody deserves "rights". Is "lawcare" not a constitutional right? Should not the government make sure you and everybody else have equal access to rights, to lawyers etc? What a great field to start, so let's nationalize the legal system! All lawyers paid by the goverment, by fixed rates that are determined by some far away university commission, adn maybe they should be paid "by the case". And, just to make things equal to medicine, they should be forbidden to charge anything more that what the government pays them - ever. And, please institute pay for performance, now that you are at it....

Friday, May 23, 2008

Massachusetts - How Not To Reform Health Care

Here is an article of the Wall Street Journal that is worth quoting:

start quote
The New Big Dig
May 21, 2008; Page A18

Mitt Romney's presidential run is history, but it looks as if the taxpayers of Massachusetts will be paying for it for years to come. The former Governor had hoped to ride his grand state "universal" health-care reform of 2006 to the White House, but his state's residents are now having to live with what he and the state's Democratic Legislature passed. As the Boston press likes to say, it's "the new Big Dig."

The showpiece of RomneyCare was its individual mandate, a requirement that all Massachusetts residents obtain health insurance by July of last year or else pay penalties. The idea was that getting everyone into the insurance system would eliminate the "free-rider" problem of those who refuse to buy insurance but then go to emergency rooms when they're sick; thus costs would fall. "Will it work? I'm optimistic, but time will tell," Mr. Romney wrote in these pages in 2006.

Well, the returns are rolling in, and the critics look prescient. First, the plan isn't "universal" at all: About 350,000 more people are now insured in Massachusetts since the reform passed. Federal estimates put the prior number of uninsured at more than 657,000, so there was a reduction. But it was not secured through the market reforms that Governor Romney promised. Instead, Massachusetts also created a new state entitlement that is already trembling on the verge of bankruptcy inside of a year.

Some two-thirds of the growth in coverage owes to a low- or no-cost public insurance option. Called Commonwealth Care, it uses a sliding income scale to subsidize coverage for everyone under 300% of the federal poverty level, or about $63,000 for a family of four. Commonwealth Care also accounts for 60% of statewide growth in individual insurance over the last year, and the trend is expected to accelerate, perhaps double.

One lesson here is that while pledging "universal" coverage is easy, the harder problem is paying for it. This year's appropriation for Commonwealth Care was $472 million, but officials have asked for an add-on that will bring it to $625 million. For 2009, Governor Deval Patrick requested $869 million but has already conceded that even that huge figure is too low. Over the coming decade, the expected overruns float in as much as $4 billion over budget. It's too early to tell how much is new coverage or if state programs are displacing private insurance.

The "new Big Dig" moniker refers to the legendary cost overruns when Boston rebuilt its traffic system. Now state legislators are pushing new schemes to offset RomneyCare's runaway expenses, including reductions in state payments to doctors and hospitals, enlarged business penalties, an increase in the state tobacco tax, and more restrictions on drug companies and insurers.

Mr. Romney's fundamental mistake was focusing on making health insurance "universal" without first reforming the private insurance market. The "connector" that was supposed to link individuals to private insurance options has barely been used, as lower-income workers flood to the public option. Meanwhile, low-cost private insurers continue to avoid the state because it imposes multiple and costly mandates on all policies.

Hailed at first as a new national model, the Massachusetts nonmiracle ought to be a warning to Washington. Barack Obama and Hillary Clinton are both proposing versions of RomneyCare on a national scale, with similar promises that covering everyone under a government plan will reduce costs. Mr. Obama at least argues that more people would be covered were insurance more affordable. But his solution is Massachusetts on steroids – make insurance less expensive for policyholders by transferring the extra costs onto the government. Mrs. Clinton likes that but also wants the individual mandate, despite the mediocre results so far.

The real problem in health care is the way the tax code and third-party payment system distort incentives. That's where John McCain has been focusing his reform efforts – because that really does have the potential to reduce costs while covering more of the uninsured – and Republicans ought to follow his lead.

In this respect paradoxically, we can be thankful that Massachusetts ignored the cost problems that doomed other recent liberal health insurance overhauls in California, Pennsylvania, Wisconsin and Illinois. The Bay State is showing everyone how not to reform health care.

end quote

Thursday, May 22, 2008

Well, I guess it’s up to me to ask the uncouth yet obvious question: If U.S. health care is inferior to the systems of Canada and Europe, why wasn’t a rich and famous man like Senator Kennedy immediately sent to one of those places so that he could get the best care available?

As Whitecoat noted the other day, Kennedy was indeed transferred from Cape Cod Hospital, where he was initially admitted, and airlifted to … Massachusetts General Hospital. Why not Europe? Perhaps the answer lies in this international comparison of cancer survival rates for males:

UK cancer survival rate lowest in Europe
By Nicole Martin
Last Updated: 1:56AM BST 24/08/2007
Cancer survival rates in Britain are among the lowest in Europe, according to the most comprehensive analysis of the issue yet produced.

European cancer survival rates
England is on a par with Poland despite the NHS spending three times more on health care.

Survival rates are based on the number of patients who are alive five years after diagnosis and researchers found that, for women, England was the fifth worst in a league of 22 countries. Scotland came bottom. Cancer experts blamed late diagnosis and long waiting lists.

In total, 52.7pc of women survived for five years after being diagnosed between 2000 and 2002. Only Ireland, Northern Ireland, Scotland, the Czech Republic and Poland did worse. Just 44.8pc of men survived, putting England in the bottom seven countries.

The team, writing in The Lancet Oncology, found that Britain's survival rates for the most common cancers - colorectal, lung, breast and prostate - were substantially behind those in Western Europe. In England, the proportion of women with breast cancer who were alive five years after diagnosis was 77.8pc. Scotland (77.3pc) and Ireland (76.2pc) had a lower rate.

Rates for lung cancer in England were poor, with only 8.4pc of patients surviving - half the rate for Iceland (16.8pc). Only Scotland (8.2pc) and Malta (4.6pc) did worse.

Fewer women in England lived for five years after being diagnosed with cervical cancer (58.6pc) despite a national screening programme. This compared to 70.6pc in Iceland. Dr Franco Berrino, who led the study at the National Cancer Institute in Milan, said cancer care was improving in countries that recorded low survival figures. He added: "If all countries attained the mean survival (57pc) of Norway, Sweden and Finland, about 12pc fewer deaths would occur in the five years after diagnosis."

His co-researcher, Prof Ian Kunkler from the Western General Hospital in Edinburgh, said waiting lists for radiotherapy were partly to blame.

This table is from The Telegraph, which reported the results of a study first published in The Lancet. Despite the mountains of BS piled up by single-payer advocates (including Kennedy himself), it clearly showed that the U.S. health care system outperforms the “superior” systems of Europe.

A couple of weeks ago, John McCain was lambasted for having the audacity to say that U.S. health care was still the best in the world. It would appear that the Kennedy family agrees.

¶ Posted 21 May 2008 † Catron

The Cause of Spiraling Health Care Costs

A colleague of mine received my email with the “Open Letter” and my comment that I think that the third party payer system is the true root problem of the spiraling cost of health care.

He answered:

“I feel that not only is it the greed of third party payers stifling
our health care choices, the health paradigm itself is failing. The
paradigm allows for patients to abuse their bodies and then hope for a
pill/surgery/procedure to get them up and running again. This taxes
the system and rewards those who can care less about their health. It
does nothing to empower people to live healthier lives.

I completely believe in a system that allows for healthier people to
pay fewer premiums. Less utilization = lower premiums. Stop eating
your cheeseburgers and diet cokes and maybe you'll save $$, let alone
live extra years.

When a patient of mine was allowed to degrade under physical therapy
for 8 straight years under Medicare, and then regain neurological function
under my care in 2.5 months, we have a problem. Not only that,
Medicare then wants to cut him off.

Bullshit, bullshit, bullshit. How about rewarding excellence in
care and in patient behavior? Doesn't happen”

My answer:

The third party payer system does not equal “greed of the third party payers”, not at all, not at all. The third parties will always behave the same way, coming up with anything to save money. It does not matter if the third party payer is a for profit company or a government institution. The behavior will be exactly the same. roof: I have seen all the exact same shenanigans that HMOs do to us here in the US exercised by the government run "sickness fund" in Germany. No difference at all, none, zero. I cannot stress that enough.

The problem is that the people involved in making the decisions to spend the money, parties one and two have no interest whatsoever in saving money. Patients want the best, most expensive, most modern, coolest treatment of the planet and yesterday and will all the creature comforts please. Physicians want to be nice to the patients and want to earn money. The more physicians do, the more they earn....
The problem is that we are "shopping with someone else's credit card" and therefore ready to waste.

As you correctly point out, people do not care about prevention - hey, why should they, if something happens, "it's all covered" anyway, so why worry. Unless it starts to become costly to neglect your body and your health, people will not go for prevention. Anybody who says otherwise is a dreamer and lives in idealistic lalaland....

That is where the solution is:
People have to pay for their health care. Period. Problem solved. There was a large study done by the Ayn Rand foundation in the 70's: one group with an insurance that covers everything- with 5% out of pocket and one group with 50-50% out of pocket and one group where the insurance covers only 5%, and 95% are out of pocket.
What happened: the care for the 95% out of pocket was the least expensive - but they reduced health care consumption indifferently, they reduced consumption of truly needed as well as superfluous tests and treatments.

Every socialist will cry out when hearing this reasoning: "see, people are going to get breast cancer, they are going to neglect their health to save a few dollars, this is immoral, blablabla. Cry, cry...insert tear jerker anecdote here....

My reasoning: at some point in life people have to learn what is important and what is not. You might as well start now, and the earlier the better. In time, people will realize what they really need and what they don't need. Today are not the seventies and with the Internet providing information, it is easy to tell the difference between necessary and superfluous tests.

And: only when a patient asks the physician: "What is the most cost effective way of dealing with this?" and then insist on the right solution, only then will the "unstoppable increase" in health care costs abate...
Your Obgynthoughts

Wednesday, May 21, 2008

Sermo, the Open Letter and the root of all health care problems

We physicians need to talk to each other more, we need to use the Internet as a the new and exceedingly useful platform to communicate with each other. With the development of the "Open Letter", has proven that it can be be just that, a platform to stay in touch, and to exchange ideas. And it allows us physicians to talk to each other across speciality lines and across any geographical boundaries, something that is sorely needed.

We physicians need to unite. We are medicine. All the others are outsiders without our knowledge, our expertise and our skils. It is completely unacceptable that health care planning and reform is happening around tables without phsyicians. We have to stop accepting what business people and politicians cook up for health care and then expect us to swallow. We are medicine, we are it. "They" are the mere monkeys on our backs. Without us, they are nothing.

While I agree with most others in terms of the criticism of what is wrong today in health care, I am not in favor of any kind of single payer third party payer system or any other kind of overbearing, strangulating government control. Instituting a socialistic single payer system would competely and sadly miss the root problem in health care: the fact that "we are shopping with someone else's credit card".

That is the true root problem of health care systems in Europe and in the US.

I have the advantage that I grew up in Germany and Spain and now live here in the US. I have trained and practiced in Germany and in the US. I have worked in Europe and I have seen the exact, but absolutely exact same problems and developements in Germany that we see here in the US. Amazing , isn't it? The exact same problems, Now let that sink in. "Socialistic" or "capitalistic" structure of the health care system does not matter. The third party payer system is the problem.
As long as a third party pays the bills, we will encourage waste, as long as a third party pays the bills, we will overspend, as long as a third party pays the bills, costs will continue to rise "unstoppable", as long as a third party pays the bills, it will go downhill.

Stop salivating about universal health care and about the Canadian or Bristish system, stop denying the problems each of them has. Work on replacing the third party payer system with a direct patient - physician relationship. Nothing else, no outside intrusion. Then health care will be free of third party interests, free of abuse by commerce and government and the patient and physician will be in charge again, as it should always have been and as it will be again in a few years

Tuesday, May 20, 2008


Another quote from the Center for Policy Analysis reporting that US Americans have same or better access to drugs at the same cost as Canadians. If you think about it, Walmart with their $4 prescription program is excellent, it shows capitalism in action. Very successful, very cheap.

Here is the quote:

"When it comes to prescription drug policies, governments in the United States tend to be more oriented towards competitive markets while the governments in Canada tend to be more interventionist. There is a common misperception Canadian prescription drug policies tend to produce lower overall costs for consumers than American prescription drug policies. However, a recently published Fraser Institute report shows that the average personal cost burden of prescription drug spending is roughly equivalent in both countries.

For example:

In 2006, the per capita spending on prescription drugs was 1.5 percent of per capita GDP for Canadians and 1.6 percent for Americans.
In the same year, Canadians spent 2.5 percent of their personal disposable income on prescription drugs, while American spent only 2.2 percent.
Also, the number of prescriptions dispensed per capita in both countries was approximately the same, 13 prescriptions per person in Canada compared to 12.3 per person in the United States.
The fact that the personal cost burden of prescription drug spending is roughly the same for Canadians and Americans is partially explained by differences in the prices of patented and generic drugs:

Patented brand name drugs in Canada are on average about 51 percent less expensive than in the United States.
Generic drugs in Canada are about 115 percent more expensive on average than the same generic drugs in the United.
Although Canadians and Americans share approximately the same cost burden for prescription drug spending, Americans are better off because research suggests that U.S. consumers have better access to new innovative drugs than Canadians do. Canadians who rely on public drug programs suffer longer delays to access many new medicines than Americans, and are in many cases not able to access the same number of life-saving and life-improving drugs that are more commonly available to Americans, according to Fraser.

Source: Brian J. Skinner and Mark Rovere, "Same Spending, Different Access," Fraser Forum, March 2008.

For text:

For more on Health Issues:
end of quote


A bit of fresh air for the fans of single payer health care systems:, a quote from the national center for Policy Analysis:

Start quote...
"Excessive waits for health care services endured by Canadian patients have imposed huge costs on the nation's citizens according to a study from the Centre for Spatial Economics.

Other major findings:

The study of medical wait times in all 10 of Canada's provinces found excessive delays for four key procedures--total joint replacement surgery, cataract surgery, coronary artery bypass graft surgery, and magnetic resonance imaging (MRI) scans--cost the nation an estimated $14.8 billion in 2007.
This in turn lowered federal and provincial government revenues by a total of $4.4 billion, the report noted.
However, it is individuals who bear these costs. When the government controls all of health care, it looks for ways to save money, and the easiest way to save is to deny care or ration care through long waits, says Charles M. Arlinghaus, president of the Josiah Bartlett Center for Public Policy.

Rationing care by using waiting lists puts a heavy strain on an economy by incurring high costs through reduced worker productivity, says Devon Herrick, a senior fellow at the National Center for Policy Analysis. Canadian Medicare uses rationing by waiting because the cost of lost productivity is borne by the individual and employer, whereas the cost of actually providing needed care falls on the public system.

For example:

Excessive waiting for total joint replacement surgery was the most expensive byproduct of Canada's health care rationing, at nearly $26,400 per patient.
That was followed closely by MRIs ($20,000), coronary artery bypass graft surgery ($19,400), and cataract surgery ($2,900).
Herrick disagrees with the study's policy prescription, saying private care options would be more effective than increased government investment in the system.

"Canadians should be allowed to pay for care privately if they so choose. It is unconscionable to forbid patients from paying for care the public system cannot provide them in a timely manner," he says.

Source: Sanjit Bagchi, "Long Waits for Health Care Are Costing Canadians Billions of Dollars," Health Care News, June 1, 2008.

For text:

For study:

For more on Health Issues:
" end of quote

Monday, May 12, 2008

Open Letter from the American Physicians

Sign the Open Letter from America's Physicians

The time has come for physicians to come together and lead a new wave of healthcare reform. The current healthcare system is strained and unsustainable. Our patients' well-being and the dignity of our profession are at stake. The physician community has found a powerful voice on Sermo and we can use this platform to speak with consensus and act in unity.

On Sermo, the physician community has been able to start formulating strategies to refocus our misdirected healthcare system for optimal patient care. The first product of this effort is the launch of an open letter to the American public, outlining the challenges we face in delivering appropriate care. This letter also gives us the opportunity to declare our full commitment to our patients. What began with the idea of drafting a single letter has now grown into a movement that is unifying and giving voice to thousands of physicians.

The "Open Letter from America's Physicians" is the culmination of months of polling, discussions, and draft revisions on Sermo, involving the active participation of over a thousand physicians. We must now drive our colleagues to sign the letter to show the strength and scope of our unity to policy makers and the public. Sermo has pledged support to distribute the signed letter broadly via the Internet, national newspapers, and downloadable materials that we can share with our patients. These strategies will give us national visibility and generate significant media attention for our efforts.

We have finally been given a real opportunity to speak and act as one. There is power in our unity. We can build on this experience and create a viable mechanism for establishing a new paradigm that acknowledges the value of physician autonomy and patient-centered health care delivery, free from the intrusion of special interests and political motives.


An Open Letter from America's Physicians

Dear Fellow Americans,

For decades the United States has led the world in healthcare. We have enjoyed the finest hospitals, medical schools, research, technology, and resources. Unfortunately, our healthcare system has lost focus to the point where patient well-being is placed after politics, profits, and special interests. Healthcare costs are on the rise and patients have lost their freedom of choice. These trends are hurting our economy and compromising the doctor-patient relationship. As a result, it has become difficult for physicians to deliver the best possible care.

Our heavily fragmented healthcare system has made it very difficult for you, the American public, to get the care you need. As your physicians, we want to partner with you to address the critical defects of the system as outlined below:

You are paying a lot for healthcare and not receiving enough in return. Your insurance premiums continue to increase while your healthcare options are dwindling. Gatekeepers, insurance networks, and restrictive regulations limit your choice of doctors and your access to care.
You have been made dependent on complicated and expensive health insurance plans. Employers are forced to take money out of your paycheck to purchase health coverage. If you lose your job, you are left with no safety net and the money you have paid for health coverage vanishes.
The time you spend with your physician has become remarkably brief due to regulatory hurdles requiring doctors to spend more time on documentation than with you.
We believe the following factors have made our current healthcare system unsustainable:

The insurance industry's undue authority and oppressive control over healthcare processes
Excessive and misguided government regulation
The practice of defensive medicine in response to a harmful and costly legal environment

We, the physicians of the United States, will no longer remain silent. We will not tolerate a healthcare system where those without medical expertise or genuine interest in our patients' health have absolute control. This letter is merely a summary of the most important problems in our current system. We believe that by partnering with the public we can start to demand real change and formulate practical solutions.

We invite you, our patients, friends, neighbors, and employers to unite with us at this important time in the history of healthcare in the United States. Together, we can guarantee our nation a healthier tomorrow.

Please talk to your doctor about this letter and visit for more information.


The Undersigned U.S. Physicians


What can you do?

SIGN the letter here through your vote and add your voice to this nationwide call to patients.

SEND emails to colleagues and encourage them to sign. Better yet, forward this posting through "Send to Colleague".

SHARE the attached flyer with colleagues. Place it in mailboxes or post it in locations that will be seen by other physicians.