News and Analysis (September/October 1998)

Lawrence R. Huntoon, MD, PhD
Article Type: 
News and Analysis
September/October 1998
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Grim Reaper Seeks Legal Status

The article was entitled "Oregon Voters Make The State A Lab For Suicide." As you are aware, measure 51 in Oregon, which was a state proposal to repeal the physician-assisted suicide law failed by a 5-4 vote on November 4, 1997. The Hemlock Society spent a reported $137,000 to defeat the measure, and their executive director Faye Girsh is quoted as saying "the Oregon law will serve as a model for the rest of the world." Michigan is next on the list to approve physician-assisted suicide and the Hemlock Society is eager to spread this "choice" to all 50 states. A bioethicist by the name of Carrie Gordon concludes, "Doctors now have the green light to kill their patients." Others are already predicting abuses similar to those which have been exposed in the Netherlands. The executive director of The Christian Medical & Dental Society states, "Frankly, we're scared. We're scared that a shroud of secrecy will cloak this practice so that it will be impossible to expose abuses or reverse course. Doctors are not required to report that a death is an assisted suicide. They remain almost immune from malpractice prosecution. Who can prove if a doctor privately coerced a patient into killing herself? The chief witness is dead." He points out that when you're sick, "you're in no condition to battle for your life against someone who feels your time is up - and has the power to end it." Chairman of the U.S. Bishops' Committee for Pro-Life Activities, Bernard Cardinal Law predicts, "If the law stands, the right to die will quickly become the duty to die." Gee, that sounds strangely familiar ("A Medical Duty to Die?" Medical Sentinel, Vol. 3, No. 1, pp. 6-7, Jan/Feb 1998). And in a parallel to another recent Medical Sentinel article ("Managed Care, Medical Ethics, and the Killing of Patients For Profit," Medical Sentinel, Vol. 3, No. 1, pp.32-33, Jan/Feb 1998), bioethicist Carrie Gordon states, "Oregon's approval of state sanctioned killing perverts the practice of medicine and opens the door for coercion of vulnerable, suffering Americans to 'choose' an early death by profit-motivated health care companies, misguided physicians, and even well-meaning family members. In this age of skyrocketing health care costs and desperate cost-containing attempts, an early death may become a reasonable substitute for treatment and care." (The Wanderer (Vol. 130, No. 46, p.1, Nov, 13, 1997.)

More On...Private Contracting

I have been handing out a brochure from the United Seniors Association in my office to my Medicare patients along with The Grass Roots Grannies (AAPS organization) flyer. The lengthy "Health Care Freedom for Seniors: Medicare Private Contracting Examined" was an excellent piece. Former HCFA Politburo head, Dr. Gail Wilensky, notes in an article in Family Practice News that not too many physicians will be able to take advantage of the new private contracting provisions of the 1997 Balanced Budget Act (Farah Kostreski, "Medicare Opt-Out Option Not Likely to be Popular," Family Practice News, Nov. 1, 1997). And, other rumors have apparently been circulating such that "physicians who see Medicare beneficiaries will not be able to see other patients." ("Balanced Budget Act Rumor Refuted," New York Family Practice, Oct. 1997) All sorts of strange things are going around to discourage those darn freedom loving doctors and patients from exercising their constitutional rights. Right next to the above article was an article telling us that the "Stormtroopers are Coming" ("HCFA Audits NY Physicians," New York Family Practice, Oct. 1997). The American Society of Internal Medicine (ASIM) has also published "where it stands" on the private contracting issue (IM Advantage, Vol. 21, No. 11, Nov. 1997). ASIM, it seems, would like to impose all sorts of prohibitions on private contracting. They just can't seem to get away from wanting to be controlled, regulated, and prohibited by government. It's almost as if they are afraid of going through some sort of "slavery withdrawal" should they try to act like free men for a change. And, in an article in the same IM Advantage on "Is Health System Metamorphosis About Over?" a study funded by the Robert Wood Johnson Foundation tells us that competition in health care delivery has so far focused on price not quality and that they anticipate [hope for, are strongly promoting, etc.] more integration of physicians into [government-controlled] organizations. To wit, at the bottom of the same page, "Medicare announced that physicians and hospitals will share lump-sum payments for inpatient hospital services as part of a new DEMONstration Project. Six sites on the East Coast will participate in the three-year pilot that will bundle Part A with Part B payments and give them to organizations such as physician-HOSPITAL organizations (pHO) to allocate. Sounds strangely familiar to the Clinton Plan.

Managed Care - It's All in the Numbers

Managed care companies love numbers and statistics...but apparently not all numbers and statistics. We are told, for example, that the physician's "Q Score" is of utmost importance to the managed care company in assessing the "cost effectiveness" of its physicians (William Hensel, M.D., "Managed Care Game: Your Q Score is High, Do Not Collect," AMNews, Dec. 1, 1997). Basically, the more sick patients a physician treats, the higher his or her Q Score. But, there's another score that HMO CEOs aren't quite so eager to talk about - the "foot score." The "foot score" refers to how many HMO enrollees vote with their feet to leave the HMO. In the case of Medicare managed care, the HMO "foot score" varies widely but in some cases is reported to be as high as 81 percent for some plans! With HMOs across the nation hemorrhaging red ink and some dropping their Medicare managed care programs altogether because of lack of profitability, some have predicted the demise of for-profit managed care (Nathan Childs, "Demise of For-Profit Managed Care Predicted," Family Practice News, Oct. 1, 1997). Others, including the president of a multispecialty clinic in Ohio, Dr. Craig Straford, predict that everything old will be new again. "Under the new system, the real interaction will be between doctors and patients." What a novel concept!

Less Privacy Equals Better Care?

If you build the database, they will come. And, they're already starting to line up to get their hands on your private medical information. In an article written by Chicago attorney Diana McKenzie, we are told that "in many cases, the benefits available to both individual patients and the public in general through analysis of patient data will outweigh the relatively small losses of privacy involved" (Diana McKenzie, "Harvesting data: A little less privacy leads to better care," AMNews, Jan. 26, 1998). And, Ms. McKenzie wants individually identifiable data as opposed to that generic anonymous stuff because the former she feels is "often more useful for data harvesting purposes." In addition to improving the health of the nation, she says the bureaucrats could "use aggregate data to determine if doctors are ordering unnecessary tests or treatment, by comparing a doctor's patient profiles with the aggregate profiles of patients with similar conditions." Perhaps before "harvesting" this "crop" of medical data nationwide, we should have a test run on a smaller scale. Perhaps Ms. McKenzie and others who propose that a little loss of privacy is such an innocuous thing should be encouraged to publish their own private medical records complete with photographs, X-rays, mammograms, etc., so the public can see how well they stack up against the average citizen.

Computerized Medicine - A Bureaucratic Disaster?

Question: How do you know when an insurance company's computer is malfunctioning?
Answer: When it's plugged in and running!

An insurance company writes a letter to a physician to inform him they can't process his claims because he didn't include his ZIP code on the claim forms (Gary Krieger, M.D, "Bureaucracy surrounding medicine is an atrocity," AMNews, Jan. 26, 1998). The insurance company's letter, of course, contains the ZIP code. When he points out this stupidity to the insurance company they tell him "not to worry," because "so many other people were in the same boat." Then the same company's computer reassigns hundreds of his patients who had been with him for years to another physician. When he asked why, he was told the "computers told them that he was closed to new patients." This was news to Dr. Krieger. When asked how the computer determined such a thing, they replied "the computer did that automatically unless there was some override." And, he was again told "not to worry" because "you're not the first one this has happened to." Dr. Krieger concludes: "I have no idea how many of my ongoing patients have been assigned to other physicians. I have no idea how much damage has been done to my practice. I have no idea when my claims will be accepted. I have no idea when I will be paid for services rendered." But rest assured, it's all being done very efficiently and cost-effectively by the insurance company's computers - situation normal...all fouled up.

This edition of News and Analysis was written by AAPS Board of Directors member, Lawrence R. Huntoon, MD, PhD. It appeared in the Medical Sentinel, September/October 1998, Volume 3, No. 5, pp.164-165. Copyright©1998 Association of American Physicians and Surgeons.

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