According to a summary report on a comprehensive national survey, more than eight out of 10 physicians practicing in an ambulatory setting have no access to any form of electronic health record (EHR), and only four in 100 have access to a full-function EHR system, despite four years of federal ballyhoo of health information technology (Modern Healthcare 6/18/08).

The report was funded by the Office of the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services, and the Robert Wood Johnson Foundation. Three authors receive support from GE Corporate Healthcare, and author and spokesman David Blumenthal, M.D., M.P.P, is an advisor to the presidential campaign of Barack Obama.

Given the low current availability of EHRs, “the U.S. healthcare system faces major challenges in taking full advantage of EHRs to realize its health goals” (ibid.).

The majority of physicians reported being satisfied with their EHRs (93% of the 117 with fully functional systems and 88% of the 2,160 with basic systems). The four possible responses, “very satisfied,” “somewhat satisfied,” “somewhat dissatisfied,” and “very dissatisfied” were combined into two categories, “satisfied” and “dissatisfied.” The possibility of a bias in the respondents, especially greater receptivity toward and facility with EHRs could not be excluded; the response rate was 62%.

Most of those with fully functional systems reported averting a known drug allergic reaction (80%) or a potentially dangerous drug interaction (71%), being alerted to a critical laboratory value (90%), ordering a critical laboratory test (68%), or providing preventive care (69%)—at least once.

Cost was the biggest barrier to adoption, the researchers concluded. “The cost of achieving widespread adoption of electronic health records in the United States could be high, probably in the tens or hundreds of billions of dollars” (DesRoches CM, et al. N Engl J Med 2008;359:50-60).

In its recent survey on Health Information Technology (HIT), AAPS included many of the items on the survey used by DesRoches et al. The AAPS survey asked about additional potential barriers, which proved to be just as important. Disruptions to practice were cited by 75%, third-party or government interference with decision-making by 77%, and potential linkage with pay for performance by 66%.

Concerns about how electronic technology could affect clinical reasoning are explored in a general way by Nicholas Carr in the July/August issue of Atlantic, “Is Google Making Us Stupid?”

The boon to thinking and research brought by the internet comes at a price. “As the media theorist Marshall McLuhan pointed out in the 1960s, media are not just passive channels of information. They supply the stuff of thought, but they also shape the process of thought.” Our ability to interpret text and make rich mental connections could suffer, as the brain reprograms itself in response to the new media, Carr suggests.

Additional information:

• “EMR—a Nonconsented Experiment,” AAPS News, July 2008.
• “Electronic Panacea,” AAPS News, April 2008.
• “Record for Data Loss Set in 2007,” AAPS News of the Day 1/15/08.

According to an annual study released by Fidelity Investments, a couple retiring this year will need about $225,000 to cover lifetime medical costs. The study assumes no employer-sponsored retiree coverage. It includes Medicare premium payments, copayments, and deductibles, as well as out-of-pocket prescription drug costs.

The figure has increased 4.7% since 2007. Fidelity’s first study in 2002 found that a couple needed $160,000 in savings to fund medical costs in retirement. Given current levels of savings, 6 in 10 retirees are “at risk” of not being able to maintain their standard of living (Eileen Alt Powell, Associated Press 3/6/08).

The very first cause listed for the rising costs, notes Dr. Lawrence Huntoon, is “the cost of a doctor’s visit”—expected Medicare fee cuts notwithstanding. Other causes are stated to include increased utilization, new technology, and increasing incidence of chronic diseases such as diabetes.

The study assumes, apparently, that Medicare will somehow be able to continue current premiums and benefits.

The federal government projects that by 2017, consumers and taxpayers will spend more than $4 trillion on medical care, $1 of every $5 spent, with the amount increasing at nearly three times the rate of inflation. The percentage paid by federal and state governments is projected to increase from 46% in 2006 to 49% over the next decade.

“Medicare, on its current course, is not sustainable,” testified Health and Human Services Secretary Michael Leavitt (Kevin Freking, Associated Press 2/26/08).

Neither John McCain, Hillary Clinton, nor Barack Obama listed dealing with the coming crisis in financing retirees’ medical care among their stated goals, according to the Kaiser Family Foundation. Obama calls for “expanded public insurance.”

The AMA’s National Health Care Policy Agenda also fails to mention this problem. It simply calls for Congress and the next Administration to “permanently replace the flawed payment formula.” Nor does the AMA allude to the problem in its ten questions for candidates.

Additional information:

• “Economic Shocks Straight Ahead?” AAPS News of the Day 3/6/08.
• “Bankruptcy,” AAPS News, March 2005.
• “Here I Stand” by Jack Schreiber, M.D., J Am Phys Surg, Winter 2004 (presented at 1967 AAPS Annual Meeting).

Nothing probably shows the potential of health savings accounts (HSAs) better than their enemies’ attempts to wreck them. An attempt to load on costly administrative requirements passed the House of Representatives but not the Senate. President Bush had threatened to veto it. Expect it to come back.

H.R. 5719 would have required every HSA transaction to be reviewed and verified as a legitimate medical expense. Currently, such expenditures are subject to an IRS tax audit, and many are made with a debit card that is only useful at a facility providing medical supplies or services.

A Wall Street Journal editorial called it “Health Savings Sabotage,” with a key player being Rep. Pete Stark (D-CA), who views HSAs as a “weapon of mass destruction.” While Democrats, including Barack Obama and Hillary Clinton, decry the high cost of medical care, including insurance overhead, “Mr. Stark and his friends want to impose the same bureaucratic overhead even on spending that consumers do with their own money” (Wall St J 4/19/08).

Cheating is a nonproblem, the editorial stated: “In any case if people cheat on their HSAs, they are only cheating themselves.”

Lobbying for the provision was EvolutionBenefits, which makes software used for “substantiation” of expenses in employer-owned Flexible Spending Accounts. H.R. 5719 would have enabled EvolutionBenefits to charge twice as much for administering HSAs.

“This is a near perfect example of the corruption of Washington,” writes Greg Scandlen. “A powerful member of Congress using his authority to benefit a single company at the expense of millions of consumers and taxpayers” (Consumer Power Report #123, 4/23/08),

“The message is clear,” writes Dan Perrin of the HSA Coalition, “we (the Democrats) think you cannot make your own decisions, so we are going to force you to pay a company to review your decisions and then we will give you access to your own money but only after we decide whether you made the right choice in the first place.”

Since HSAs were created in December 2003, 3.2 million accounts have been opened, covering 4.5 million Americans, one-third of whom were previously uninsured and bought coverage on their own. Thirty-three percent of new users are small businesses that previously had not offered coverage to their employees.

Consulting firm Watson Wyatt found that average health-insurance costs in the last two years rose 3.6% for employers who offered high-deductible accounts, versus 7% for employers who did not (Wall St J 5/1/08).

According to the U.S. Government Accountability Office (GAO), the number of tax filers reporting an HSA tripled between 2004 and 2007 (GAO-08-474R).

“The take-up rate is the fastest of any benefits innovation of our lifetimes, states Greg Scandlen. “Faster than IRAs, 401(k)s, and far faster than HMOs. The only thing that rivals it may be the conversion of HMOs into PPOs in the mid to late 1990s.”

“Which is probably one of the main factors in pushing H.R. 5719,” writes Frank Timmins. “HSAs are a threat to the SP [single payer] crowd. They need to slowly poison this baby before it grows to maturity.”

Additional information:

• “HSAs Have Dramatic Growth Spurt,” AAPS News of the Day 3/23/06.
• “Frequently Asked Questions (FAQs) on Consumer-Driven Medical Care.”
• “Tax-Advantaged Medical Coverage,” by Madeline Pelner Cosman, J.D., Ph.D.

After much criticism and the filing of a lawsuit by AAPS against it, the Texas Medical Board (TMB) will host a series of town hall meetings this summer. This exercise is supposedly to “gather input and feedback about regulation of the medical profession.”

“We want to encourage a more active dialogue with doctors and with the public,” said TMB Board President Roberta Kalafut, D.O. “The impressions we have as regulators may not mirror the impressions of the licensees.”

But none of the scheduled town hall meetings are in the Houston area, by far the largest city in Texas. Instead, the town hall meetings are scheduled for places including Brownsville, which is located in the difficult-to-reach most southern region in Texas. Midland, another location for these meetings, is even more remote.

The TMB has done nothing yet to end its arbitrary and abusive practices, although one of the key participants has resigned and a second has announced his resignation.

According to a TMB press release, it “has already instituted two changes that will benefit licensees. The first, a ‘fast-track’ enforcement system that allows physicians who face relatively minor administrative violations to dispose of those charges without needing to attend a hearing.”

The second, the License Inquiry System of Texas (LIST), allows applicants to check the status of their applications and to learn what items are required to process it.

At the October 23 hearing before the Texas legislature, many physicians gave compelling testimony about how minor or nonexistent issues were converted into career-ending injustices. The transcript of that session is available on our website at http://www.aapsonline.org/tmb.php.

Each town hall meeting will begin with a 7 p.m. town hall, and continue with a three-hour licensing seminar on the following day. The seminar is intended to help entities that credential or recruit physicians to streamline their application process and minimize errors.

The schedule (also posted under “news,” “press releases” on the TMB website www.tmb.state.tx.us) is as follows:

 June 9/10, Brownsville, TX: Brownsville Event Center, 1 Event Center Blvd. Seminar begins at 8:30 a.m.

June 17/18, Midland, TX: Center for Energy and Economic Diversification, 1400 N. FM 1788. Seminar begins at 8:30 a.m.

June 23/24. Austin, TX: Town hall in the Thompson Auditorium of the Texas Medical Association Offices, 401 W. 15th St. Seminar in Room 100 in the lobby area at William P. Hobby Jr. State Office Building, 333 Guadalupe St. Seminar begins at 11:00 a.m.

July 1, 2, Fort Worth, TX: University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Luibel Hall, 2nd floor of EAD building, corner of Montgomery and Camp Bowie. Seminar begins at 8:30 a.m.

July 8/9, Bryan/College Station, TX: Lecture Hall 1, Joe Reynolds Medical Building, Texas A&M, southwest corner of University Drive and Olsen Blvd. Seminar begins at 8:30 a.m.

Please show up, speak out, and consider making a lawful tape recording. Suggest questions to ask by posting a comment below.

Additional Information:

• “Questionable Tactics Forcing Changes at Texas Medical Board” by Steven F. Hotze, M.D., ExaminerNews.com 4/15/08.
• “White Paper in Opposition to Federation of State Medical Boards (FSMB) Proposal on Maintenance of Licensure” by Jane M. Orient, M.D., J Am Phys Surg, Spring 2008.

The Senate is poised to vote on S. 2191, the Lieberman-Warner cap-and-trade scheme for reducing carbon emissions, which would cost the U.S. economy an estimated $1 trillion to $2.8 trillion by 2050. When gasoline and electricity price increases are taken together, 90% of Americans reject even the low-range estimates of the measure’s costs. Meanwhile, truckdrivers and fishermen are snarling traffic and blockading ports in Europe, protesting “green” taxes.

The Lieberman-Warner bill “would impose the most extensive reorganization of the American economy since the 1930s,” states the lead Wall Street Journal editorial for May 27. It involves the government’s creation of a new commodity—the right to emit carbon dioxide—and puts a price on it. This constitutes an indirect tax that “would profoundly touch every corner of American life.”

Not only is it a giant revenue grab, but it gives politicians the right to influence the price of every good and service in the economy. In 157 pages of amendments submitted by Sen. Barbara Boxer (D-CA) is $800 billion in consumer tax relief through 2050 to return a small fraction of the regressive tax revenues to the politically chosen. It’s a “massive income redistribution scheme” mediated by Boxer and “her fellow Platonic rulers.”

The National Center for Public Policy Research commissioned a survey of 802 people on how much they’d be willing to pay in an effort to reduce greenhouse gas emissions. Respondents were given a choice between spending “nothing more,” a percentage increase correlating to estimates from three different econometric analyses of Lieberman-Warner, and a percentage increase just below the most optimistic of these projections.

About 65% of Americans reject spending even a penny per gallon more for gasoline, and 71% reject spending more for electricity. Only 6% would be willing to accept the gasoline and electricity price increase ranges forecast by any of the three studies.

The actual number rejecting the costs would be even higher, suggested David Ridenour, if they considered the inevitable price increases in other consumer goods, and the fact that many Americans would lose their jobs.

“As amazing as it is that 90% of the public agrees on anything,” said Ridenor, “is the fact that all three of the major presidential candidates—Senators Clinton, McCain and Obama—favor a proposal the public appears to be almost unanimously against.”

The goal of Lieberman-Warner is to reduce carbon dioxide emissions to 2005 levels by 2012, and by a further 30% by 2030. It assumes that every coal-fired generating station in the U.S.—the source of 50% of our electricity—would be shut down (Wall St J, op. cit.).

Europeans will fail to meet far more modest Kyoto goals. Because of the expense of the effort, “insurrection is in the air,” writes Nick Clegg (Daily Telegraph 5/28/08). The Labour Party got its biggest hammering in 40 years in recent UK elections (Civil Defense Perspectives, May 2008). A British polling firm showed that more than 70% of voters are not willing to pay any higher taxes on the pretext of combating climate change. Much of France ground to a halt last week in strikes over fuel taxes, resulting in clashes with riot police. Fishing fleets blockaded French ports and blocked cross-Channel ferries. Italian, Greek, and Portuguese fishermen have threatened to join the protests (Globe and Mail 5/28/08, AFP 5/27/08, posted by Benny Peiser to the Cambridge Conference Net 5/28/08).

All this to reduce the human share (4%) of global carbon dioxide emissions. The upshot of Lieberman-Warner is that “trillions in assets and millions of jobs would be at the mercy of Congress and the bureaucracy, all for greenhouse gas reductions that would have a meaningless impact on global carbon emissions if China and India don’t participate. And only somewhat less meaningless if they do” (Wall St J, op.cit.).

The Lieberman-Warner bill is, of course, based on the dubious assumption that returning to the carbon dioxide emissions of a pre-industrial economy would somehow improve the climate.

Additional information:

• “32,000 Scientists Dissent from Global Warming ‘Consensus’,” AAPS News of the Day 5/20/08.
• “Pressure to Restrict Energy Use Intensifies; Opposition Also Builds,” AAPS News of the Day 11/20/07.
• Lieberman-Warner Bill, Boxer Amendment, Regulations and Mandates.

Widely trumpeted in the press, a nonscientific survey shows that 59% of American physicians purportedly favor legislation to establish national health insurance (NHI), while only 32% are opposed.

“The debate over physician support of national health insurance is over,” comments Don McCanne, M.D., on the website of Physicians for a National Health Program (PNHP).

The survey was published as a letter to the editor in the April 1 issue of the Annals of Internal Medicine (2008;148:566-567). Authors are Aaron Carroll, a board member of PNHP, and Ronald T. Ackermann, M.D., M.P.H., associate director of the Center for Health Policy and Professionalism Research at Indiana University. [In the 2008 Annals and in some reports, the name is spelled “Ackerman.”]

A survey sent to 5,000 randomly selected names from the AMA Physician Masterfile asked two questions: 1) “In principle, do you support or oppose government legislation to establish national health insurance?” 2) “Do you support achieving universal coverage through more incremental reform?” Responses were received from 2,193 physicians, or 51% of the 4,294 eligible participants. (Responses from physicians no longer in active practice were discarded.)

In answer to question #1, 38% “strongly” and 31% “generally” supported NHI; 9% were neutral; 17% “strongly” and 15% “generally” opposed it. In response to question #2, 14% “strongly” and 41% “generally” supported “incremental reform”; 21% were neutral; and 14% “strongly” and 10% “generally” opposed it.

Support for government health insurance has increased by 10% since the last survey in 2002, claimed a PNHP press release. However, sampling methodology was quite different in the earlier, more rigorous survey, and question #2 was dramatically changed. In 2002, the question read: “Do you support or oppose a national insurance plan where all health care is paid for by the federal government” [emphasis in original]. Only 26% supported this option (only 9% “strongly”), while 60% opposed it (27% strongly). (Ann Intern Med 2003;139:795-801)

Doctors least likely to support government payment for care were male, “non-minority” specialists in private practice in rural areas, whose practice was less than 20% Medicaid. Authors Ackermann and Carroll were “surprised to find that fewer than 50% of family practitioners supported government legislation to establish national health insurance,” and suggested this might be explained by the fact that FPs were more likely than internists or pediatricians to have a rural practice.

The bias of the authors seemed apparent in the 2003 abstract. “Background:… National health insurance would remedy this situation [of 40 million uninsured], and many believe the success of reform efforts in this direction may depend on physician support…. Conclusions: A plurality of U.S. physicians supports government legislation to establish national health insurance. This support may be relevant to the success of future efforts to reform national health care.”

AMA Board of Trustees chairman Edward L. Langston, M.D., said it was difficult to draw conclusions from the 2007 survey because of “possible confusion over its terminology” (AM News 4/21/08).

The survey was “pure propaganda,” stated Greg Scandlen of Consumers for Health Care Choices, noting that the sample was self-selected, and the contents of the cover letter unknown. “It might have been calculated to infuriate physicians who believe in freedom, resulting in these doctors discarding the survey.” He compared it with a Commonwealth Fund survey a few years ago, which purported to show that employers supported an employer mandate. Scandlen found that the survey permitted only two choices: an employer mandate or single payer (Consumer Power Report #122, 4/3/08).

Desperation resulting from being mugged by managed care is one suggested explanation for the results.

Additional information:

• “White Paper on Medical Financing” by Andrew Schlafly and Jane M. Orient, J Am Phys Surg, Fall 2006.
• “Why the United States Should Reject Socialized Medicine (a.k.a. ‘Single Payer’)) and Restore Private Medicine,” AAPS brochure; 2003.