Maxis, the computer game software company based in Orinda, has produced the game SimHealth: A Democracy and Society Computer Simulation, a game that lets you construct your own national health care strategy and try it out in a simulated U. S. Economy. You can start with 1) the Clinton system, 2) the Republican alternative of free market reforms, or 3) the Canadian system. If your system draws money from other programs, the Main Street shrinks; if you cut doctors’ salaries too much, they decline and hospital waiting rooms overflow; if your health care plan inflates the federal deficit, the government buildings begin to decay. . . appears to be as logical a way of doing it as any. But what happens when all those extra patients go through that high cost center?

What does health security cost? Job security, according to cartoonist Asay in the Colorado Gazette Telegraph.

Speaking of Canada, K. L. Billingsley, (Freeman, 44:2-3, 1994), suggest that as we talk about the Canadian Health Plan, that we be sure to look at the entire picture. He reports that as Eastern Europe was throwing off the chains of socialism in 1990, Ontario, Canada elected a Socialist government. In May, 1993, Ontario increased tax levies by $1.6 billion: added a sales tax on auto insurance; increased the state taxes to 58% of the federal; increased the surtax (tax on the tax) to 20% on incomes over $51,000; increased the surtax an additional 10% for those earning over $67,000 (double tax on tax); a tax on charitable contributions of 5%. The workers are now asking for non-taxable benefits such as more vacation time. People began swapping services to avoid tax, so the government slapped a tax on barter services. Can you believe if your neighbor helps you out, you would have to pay a tax on the services he gives you free? That should put a damper on being neighborly. He estimates the underground economy at over $100 billion. Isn’t that making tax evasion criminals out of ordinary citizens?

Former State Senator Alan Robbins, Inmate No 05957-097 at Lompoc Prison Camp, wrote an open letter to the new California state legislators of 1993 in the Sacramento Bee, Sunday December 12, 1993. After 19 years in the Senate, lead author on 448 bills that became law he states: “How long can you kid yourself into believing you are so perfect that you can accept large contributions without being influenced?”

Herbert A. Sample of the Sacramento Bee’s Washington Bureau, reports Citizen Action found the following recipients of health industry moneys in the House: No. 1 was Jim Cooper, D-Tenn with $163,846; No. 2 was Fortney “Pete” Stark, D-Hayward with no amount given; No. 6 was Robert Matsui, D-Sac, with $54,500; Vic Fazio, D-W Sac, trailed at $32,350. Among the Senators was Dianne Feinstein with $59,000 and Barbara Boxer with $16,500. The health care industry donated $5.6 million this year, a jump of 31%. Maybe Robbins should send the same open letter to the federal lawmakers?

The Chronicle staff writers state that industry watchers predict an eventual link-up between California Health Systems, Health Dimensions (who hired Dr. Molly Coye) and Sutter Health. Not long before our own hospitals won’t even know us – because they are somewhere else.

The legislature passed and the governor signed over 1300 bills last year with over a 1000 going into effect this year. Aren’t we reaching a point of diminishing returns? Many of our patients have difficulty remembering even 10 recommendations including medications. Who can remember 1000 new laws and regulations per year? Do you suppose a lawyer can remember 1000 new laws a year? Or 40,000 new laws per legal career? Maybe big cuts in the law making machine would balance our budget.

A lady called one of our surgeons recently requesting a brochure on hernia repair to send to her brother in Norway. He had been on the waiting list for a hernia repair for two years and called to see how he was progressing up the list. He was told there were still over 2,000 ahead of him. When they asked his age he was told that he probably would not be able to have the hernia repair in his lifetime. . . We always knew that government medicine had a secret way of dealing with cost containment.

Marc S. Micozzi, MD, PhD, a physician and anthropologist who directs the National Museum of Health and Medicine in Washington, D.C., recently brought from Berlin the exhibition, “The Value of the Human Being: Medicine in Germany 1918-1945.” He notes that socially minded physicians placed great hope in a new health care system, calling for a single state agency to overcome fragmentation … Medical concerns changed from the private domain of the nineteenth century to a concern of the state… The physician transformed into a functionary of state-initiated laws and policies. He states that it is one thing to see oneself as responsible for the “nation’s health” and quite another to be responsible for an individual patient’s health. The mentally ill having been released from their chains in the nineteenth century and placed in community and family contact, were returned to state institutions to become the ultimate victims of state “solutions.”

The exhibit continues with a pamphlet, The Sanctioning of the Destruction of Life Unworthy of Living, published in 1922 by Alfred Hoche, a neuropathologist, and Karl Binding, a lawyer. This set the stage for the mentally ill and the mentally retarded to be sterilized and subjected to euthanasia in large numbers… And to think that doctors supported all this with their desire for a single-payer health system!

Dr. Alain Enthoven from the Stanford Business School recently spoke at the California Health Forum at our convention center. After pointing out that the federal government wastes 48 cents of every tax dollar, Enthoven presented data that socialist nations around the world are turning to market based economies because they work better than government controlled economies. He stated we must move promptly to universal coverage primarily by people who can afford their own coverage. We must have accountable health plans. Fee for service medicine with remote third party model pays more for more, not better care. He pointed out many failures of the Clinton plan, that would be disastrous to care, rather like, “Other than that, Mrs. Lincoln, how did you enjoy the Play?”

Enthoven also touched upon the predictable failure of proposition 103. Remember this was the assault of some citizens, who obviously never passed junior college economics 21, on the auto insurance industry by trying to reduce their income by 20%. Many of us in the business/professional strata of society are more worried about insurance companies being able to pay their liabilities to us, e.g., a $1 million liability judgement, or a $100,000 CABG, or a $25,000 car that was totaled by an uninsured driver. I appreciated my insurance agent taking me out of Executive Life two years before its bankruptcy because he recognized that they might not be able to pay my wife a quarter million to cover my obligations should I check out. In this country as long as we have a market environment, we can rest assured if someone sells a product at a price that’s too inflated or of inferior quality, there will be someone that will enter the market with a better product or policy at a reduced cost. Remember the foreign car companies across the Pacific that gave Detroit a run for its life?

RADAR, the newsletter on radar and transportation issues, states that insurance companies are now giving communities free “Photo Radar” devices. In our community, Roseville and Folsom had “Photo Radar.” However, Roseville did not renew their initial two year agreement. Although there are 13% of drivers that knowingly exceed the speed limit, it has been estimated that 75% of drivers may exceed speed limits briefly without intent, and thus if they live or work in Folsom, eventually will be cited. The car insurance companies that in the past allowed two or three moving violations before they doubled your insurance premium, now, after proposition 103, are able to rate you a “bad driver” after one violation, even though you are an excellent driver, and can double the insurance premium. The proposition 103 assault on insurance companies has been a gold mine to them and an assault on citizens.

Not unlike the government making an assault on us under the pretext of decreasing health care costs. If we don’t articulate our position well on behalf of our patients, the final assault will be on them. We will be working for the government and our patients will essentially be wards of the state.

Congratulations to Sutter General and Mercy Hospitals on their accolades from the Office of Statewide Health Planning and Development for having a lower than average complication rate for several forms of back surgery. To have several competing hospitals singled out in one community suggests a common denominator among them. Could it be the surgeons are the key element for these excellent surgical results? (Bee 12/9/93)

Recent headlines in the Wall Street Journal stated “The VA declares War on Health.” In the staff room discussion that followed one surgeon mentioned that when he was a resident in surgery in the VA, a nurses aid complained to him that the patient wouldn’t swallow. The food just ran down the side of his mouth and onto his shirt. The surgeon did a quick assessment and found the patient dead. Thank God for government medicine–otherwise this poor lady would not have a job.