The Modus Operandi of Managed Care (January/February 1999)



Author: Thomas Dorman, MD
Article Type: Feature Article
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


In contemporary America, we are suffering from a lack of concepts, a philosophical vacuum recognized first by Ayn Rand. Nowhere is this more marked than in the fascist take over of the oldest profession. The ethics of physicians have been wardens of Western traditions since the days when Hippocrates formulated his famous Oath. The personal relationship and direct individual responsibility between physician and patient, the laissez faire capitalist system, was encapsulated in the honorable commitment to the patient, long before Ludwig von Mises wrote Human Action. The relationship between any buyer and purveyor contains what this writer defines as a point of transaction. This concept is introduced to convey the idea of the moment of decision for the exchange. For instance, when I go to the...




Author: John C. Sonne, MD
Article Type: Feature Article
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


This article describes how the ever increasing control by third party payers of the physician-patient dyad is reinforcing family dysfunction and producing a regressive deterioration of the health care system into a system resembling that of a dysfunctional family. A component contained in both systems is a lack of respect for autonomy and individual freedom through the exercise of tyrannical control in the name of compassion and care.   The Erosion of Liberty by the Misuse of Words   James Madison made the point over a century and a half ago that the real threat to the erosion of liberty comes not from major and conspicuous changes, but from small steps that are scarcely discernible. This caveat applies to the health care reform movement. The small steps by which liberty is...




Author: Balint Vazsonyi
Article Type: Feature Article
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


In his second Inaugural Address, President Clinton called for a new Constitution. He borrowed language from the Declaration of Independence where, in 1776, Thomas Jefferson presented the argument for a new government. While Mr. Clinton did not refer to the Constitution in so many words, his meaning was clear. "We need a new government for a new century," he proclaimed on January 20, 1997. Unlike our present one, his new government would "give" a number of benefits to the American people. We at the Center for the American Founding disagree. We believe that our present form of government, as articulated in the Constitution, brought forth the most successful society in the history of Planet Earth. Indeed, the country that was established here more than two centuries ago is one of a kind. No...




Author: Hilton P. Terrell, MD, PhD
Article Type: Editorial
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


The obstacles to the practice of ethical, efficient, private medicine continue to grow noticeably, month by month. Illegitum non Carborundum says the sign on the bulletin board. It seems to have been overruled in Washington and countless state and corporate offices. The fatherless ones crank up new machines of torture with the added insult that I am required to finance their inquisitional torments. Their wheels grind exceedingly fine. A patient who suffered a stroke would be more comfortable with a simple tray-like armrest bolted to one arm of her wheel chair. Six forms, one of them an error, and a phone call result. The medical supply house gets $110 for what could not cost more than $25. I get only headaches and a threat of jail and fines if I cannot substantiate what I approve. The...




Author: Robert P. Gervais, MD
Article Type: Commentary
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


Dear Dr. Spaeth: I was pleasantly surprised to receive your letter which briefly discusses the ethical concerns I have about the managed care organization (MCO) philosophy. The theoretical underpinnings of the MCO concept are wrong on both utilitarian and moral grounds. Having made such a sweeping assertion, let me attempt to explain my position which many regard as extreme but others view as simple common sense. My critical thesis of the MCO philosophy hinges on what I have chosen to label the premium-claim problem. I define a claim as a payment mechanism or a fee paid by patients either directly or indirectly which by its very nature allows patients and providers to engage in mutually beneficial exchanges. I will define a premium as a payment mechanism or a fee paid by a consumer to...




Author: Lawrence R. Huntoon, MD, PhD
Article Type: Medical Ethics and Managed Care
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


The year is 2025. In an attempt to understand the tragic demise of American medicine in the tradition of Hippocrates, we look back on the course of events around the turn of the century. The concept of Euthanasia Centers actually developed rather insidiously, yet over a relatively short period of time. It began with the widespread acceptance of managed care as a means of reducing health care expenditures at any cost. Once society as a whole became accustomed to the bottom line driven form of health care where savings accrue and HMO profits are made by withholding medical care, it was only a series of short steps to the formation of the Euthanasia Centers. The precedent of judging "quality of life" for those in the earliest stages of life had already been set, and given the unrelenting...




Author: Leah S. McCormack, MD
Article Type: Correspondence
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


Dear Dr. Faria, It was a pleasure to meet you at the AAPS meeting. I am telling all my physician friends to join AAPS. So often, doctors in private practice feel as if there is "no hope." A weekend spent with physicians who value freedom, and are willing to fight for it, was a big boost. In my mail on my return was a copy of Dermatology World. I thought you would be interested in page 5.* Leah S. McCormack, MD Forest Hills, NY * Resolution 198.4 --- Capitation's Impact on Medical Ethics: The American Academy of Dermatology (AAD) Ethics Committee or another appropriate committee or task force draft a position statement on capitation which would assess the impact of capitation on the individual patient, as well as the effects on the physicians.... The deliberations that the Ethics Committee...




Author: James Bovard
Article Type: Correspondence
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


Dear Dr. Faria, Thanks for sending me copies of your articles from the Medical Sentinel; I enjoyed them very much. Speaking to you and the other AAPS members at the convention in Raleigh was most encouraging. I am glad to see a bunch of savvy freedom fighters with the courage to stand up to Big Government... All the best, James Bovard Rockville, MD Correspondence originally published in the Medical Sentinel 1999;4(1);1-2. Copyright©1999 Association of American Physicians and Surgeons (AAPS).




Author: Joseph M. Scherzer, MD
Article Type: Correspondence
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


Dear Editor, Democrats and Republicans are engaged in a political test of wills to find the "right" answer to the multitude of ills created by HMO medicine. While Democrats are trying to say their Patient Bill of Rights is bigger and better than the Republican plan, the Clinton administration is asking an appeals court to overturn a tremendous victory won by Medicare HMO patients which gave them significant consumer protections and new rights. But, we must remember this is the same administration that told people over 65 they had no right to escape the functional and intentional rationing of their Medicare entitlement by choosing private medical care on a case by case basis. The best prescription for recreating the health care free market which existed before World War II would be to...


HMO


Author: Jane M. Orient, MD
Article Type: Correspondence
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


Dear Editor, I take exception to the list of hazards in the home as presented by John Graham of the Harvard Center for Risk Analysis. Only some of the risks are based on actual statistics (numbers 2-6). Numbers 1 (indoor radon), 7 (environmental tobacco smoke), 8 and 9 (formaldehyde gas and insulation fibers), and 10 (electro-magnetic fields) are based on extrapolation, poor statistics that probably do not account for confounding variables, and pure speculation. Most of them help to support more intrusive regulation by the Environmental Protection Agency. Note that real deaths from accidental electrocution are not on the list, whereas hypothetical deaths from EMF are. Instead of causing deaths, "risk" number 1 probably prevents them. Undoubtedly, high-dose radon is carcinogenic. From the...


DDP


Author: Howard Long, MD
Article Type: Correspondence
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


Dear Editor, Canada's Medicare for everyone has devalued doctors, patients, and the Canadian dollar. But in the U.S.A., socialist propaganda continues, like the BORG of Star Trek, "You will be assimilated!" Patient protection from HMOs by government is fraud. The U.S. Ninth Circuit Court of Appeals affirmed, "Government cannot avoid the due process requirements of the Constitution merely by delegating its duty to determine Medicare coverage to private entities" (Grijalva v. Shalala # 97-15877). So HMOs are part of government, and government does not protect you from government... Economist Milton Friedman advises, "Follow the money..." [Only] medical savings accounts (MSAs) provide escape from health [care] tyranny...managers fear the competition...The president vetoed the entire federal...




Author: Compiled by Medical Sentinel Editors
Article Type: News Capsules
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


Canadian Health Care While Canadian physicians have been going on strike protesting the deterioration of medical care which continues to be rationed for Canadian citizens --- Canada's defense department confirmed on Sept. 2 that the military has agreed to pay for sex-change operations. "Our decision was based on our assessment of whether someone who had had [sex-change] surgery could serve in the military. The advice we got from the specialists we consulted was that once somebody had been successfully treated, they should not be restricted from any military duties," noted Col. Scott Cameron, director of medical services for the military (The Washington Times, National Weekly Edition, Sept. 14-20, 1998). "Sex-change operations had been covered by most of Canada's provincial health plans...




Author: Lawrence R. Huntoon, MD, PhD
Article Type: News and Analysis
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


More Government Tracking and Guidelines The State of New York recently wrote letters to practicing physicians within the state notifying them the state's peer review organization (Island Peer Review Organization --- IPRO) was tracking their management of atrial fibrillation in Medicare patients. A copy of the state's recommendations for treatment was enclosed with the letter. Their letter also contained the declaration that they are the "Experts in Defining and Improving the Quality of Healthcare," just so there would be no misunderstanding about who was in charge. In the past, when physicians deviated from the state's guidelines, the state took punitive action by assigning the physician quality deficiency points. Some of the so-called "quality issues" cited were astonishing. In 1990, the...




Author: James P. Weaver, MD
Article Type: President's Page
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


At our national meeting in Raleigh, North Carolina last fall, there were many presentations on the Kassebaum-Kennedy law provisions allowing for the investigation of fraud and abuse in the Medicare system. Physicians, it now seems, potentially face armed invasion of their "private" offices by federal agents who will be enforcing the ever increasing regulations of this misguided program. These new tactics, this escalation in the use of intimidation and terror, will come as no surprise to those who have examined the political and philosophical basis of Medicare. At its best, Medicare, a medical care program for the elderly and the disabled, is a government program ultimately based on force --- and that is where the "best" ends. Medicare is a wealth redistribution scheme in which property in...




Author: Miguel A. Faria, Jr., MD
Article Type: Editor's Corner
Issue: January/February 1999
Volume Number: 4
Issue Number: 1


When our Founding Fathers met during the deliberations of the Constitutional Convention in Philadelphia (May-Sept. 1787), they established the impeachment process as the constitutional remedy for those public servants who would potentially violate the public trust. The impeachment process was part of the carefully crafted system of checks and balances, separation of powers, and limited government with the consent of the governed, and other enlightened principles inherent to a constitutional republic. They deemed a republic to be the best and highest form of government, whereby men are endowed by their Creator with the inviolable and inalienable natural rights to life, liberty, property, and the pursuit of happiness. These natural rights preceded government and were granted by God,...



It is now legend the AAPS legally lanced the secret task force and pulled its secrets...into the sunshine. It destoyed the Health Security Act.


The Oath of Hippocrates
and the Transformation of Medical Ethics Through Time


Patients within a managed care system have the illusion there exists a doctor-patient relationship...But in reality, it is the managers who decide how medical care will be given.


Judicial activism...the capricious rule of man rather than the just rule of law.


The largest single problem facing American medicine today is the actions of government...


The lessons of history sagaciously reveal wherever governments have sought to control medical care and medical practice...the results have been as perverse as they have been disastrous.


Children are the centerpiece of the family, the treasure (and renewal) of countless civilizations, but they should not be used flagrantly to advance political agendas...


Prejudice against gun ownership by ordinary citizens is pervasive in the public health community, even when they profess objectivity and integrity in their scientific research.


The infusion of tax free money into the MSA of the working poor give this population tax equity with wealthier persons...


It was when Congress started dabbling in constitutionally forbidden activities that deficit spending produced a national debt!


Does the AMA have a secret pact with HCFA?


The lure of socialism is that it tells the people there is nothing they cannot have and that all social evils will be redressed by the state.


Canada's fatal error — Health Care as a Right!


The Cancer Risk from Low Level Radiation: A Review of Recent Evidence...


...Moreover, the gun control researchers failed to consider and underestimated the protective benefits of firearms.


Vandals at the Gates of Medicine — Have They Been Repulsed or Are They Over the Top?