Fred Thompson, actor-turned-senator from Tennessee, was overheard lamenting, “I’ve still got a lot to learn about Washington. Yesterday, I accidentally spent some of my own money.” (TV Guide)

Klas of the Cox News Service reports concerning Florida’s suit against cigarette manufacturers. This is a landmark case that will seek at least $1.43 billion from several tobacco companies in order to recover the state’s cost of treating Medicaid patients with diseases caused by smoking. Florida will use 10 in-state law firms, one from Mississippi, and another from South Carolina. The law firms will keep 25% of what they win. With triple damages for fraud, Florida hopes to have a $4.5 billion award… Now perhaps there will be support for private health insurance premiums that have at least a 100% surcharge for smokers in order to partially pay for smokers’ increased health care costs. This may also avoid an increase in premium for those patients who, through no fault of their own, have diabetes, asthma, hypertension, cancer, etc.

Seen at William Glen was a specialty Birthday card by cartoonist Dr. Brian Moench, former instructor at Harvard Medical School. It depicted a surgeon in OR Greens with a black bag at his feet and a sign in his hand, “Will operate for food.”

At the annual respiration dinner of the Western Clinical Societies meeting at Clint Eastwood’s Mission Ranch in Carmel, we were seated next to a physician from Salt Lake City who had trained and practiced in England. She said that most physicians in England make about as much as nurses in this country. When asked to elaborate, she stated that fellows make about $25,000, senior consultants up to $45,000, and bureaucratic doctors up to $60,000. When asked what administrators make in England, she stated about $75-90,000. Looks like we’re headed to this same reversal of presumed importance. Administrator, boss, employer dominating the physician, underling, employee. The high point of our practice may soon be the Employee of the Year plaque.

A patient walks in and asks, “Can I see the Doctor?” The receptionist replies, “Do you have health insurance?” The patient asks, “Does he have malpractice insurance?” The receptionist replies, “I believe the doctor is busy.” (With thanks to the Parker strip)

The AMA, acknowledging that managed care is the driving force in the health-care system, announced a major program to help doctors finance their own health plans in order to battle for patients. The AMA is contending that doctors should try to beat the competition at its own game. “Physicians make decisions about how best to manage the patient,” said Denise Andresen, director of what the AMA calls its private sector advocacy and support team. “Why shouldn’t we take control of our futures?”… But no one seems to be coming up with a plan as to how doctors, who have a 400-1600 percent variation in how to treat the same disease, are going to reduce costs. Does this wide variation convince the planners that we really know how best to manage our patients? The doctors on the low end of the bell curve are more willing to eliminate a $40 test than the doctors at the high end of the spectrum who feel they need one more $1400 MRI. About as “Dead on Arrival” as anything can get.

Bumper sticker common in the eighties: “I’d Rather Be Fishing.” Bumper sticker of the mid nineties: “I’d Rather Be Working.”

American Medical Television still seems to be in limbo. The Saturday morning slots have in large part been bought up by health promotional programs. A diet guru was seen expounding the benefits of the HealthRider, an exercise instrument. An 86 year old lady stated that 15 minutes per day on the HealthRider has gotten her out of bed and back to walking and being active. Cost: $499 plus $49 S & H–slightly less than the Medicare hospital deductible…If this gets a lot of people out of their hospital beds, these new programs may be more effective in improving the public health than AMT ever thought. And reduce health care costs in the process.

John H. Fund, WSJ editorial page writer, notes that Washington can learn from the Canadian province of Alberta. Since Premier Ralph Klein took office during a fiscal crisis in December 1992, his reform blitzkrieg has touched–and cut–every corner of government. He wiped out the budget deficit he inherited, cut spending by 20%, reduced government jobs by 25%, abolished parliamentary pensions, refused to raise taxes, reduced unemployment from 9% to 7.2% and welfare caseloads have dropped almost in half. In fact, only 2% of Alberta’s population is now on welfare compared to 15% of Ontario’s. Two-income families earning $71,000 pay 31% less taxes than a similar couple in Toronto. Private medical clinics have been legalized. (Does this confirm that the government realizes that they are so inefficient that they can’t survive without making private practice illegal?). What astonishes Canadians is that Premier Klein’s downsizing agenda is popular, with a 68% approval rating. “Many people here think he’s just below God himself,” says John Friedt in Calgary. In issuing his austerity budget, Klein told voters, “You can’t leap a canyon in two jumps.”

Overheard in the doctors staff room Tuesday, Jan 31 after hundreds of registered letters of termination from a medical group were received the prior day by specialists: Last night was my “Krystal Nacht.” Perhaps offensive and insensitive to some, but heartfelt Practice Pain nonetheless.