Overheard in the staff room: After making flight reservations for a medical meeting in Miami, the agent allegedly asked, “Could I reserve a bullet proof automobile for you or would you prefer a tank?”

Hats off to Dr. Gordon Hunt, Chief of Staff at Sutter, for one of the finest staff presentations in memory on Tuesday, September 14, 1993. From the video on Paradigms to his review of the current health care climate to his assessment of the Sacramento innovations culminating in his predictions for the future and why it is important for physicians to support a health care system, it was very insightful. Brings back pleasant memories of some fifteen years ago when I presented a Sacramento Cocci case to my former Chief at the University of Michigan Chest Conference and first met Gordon.

The Cascade Policy Institute has predicted the results of Oregon’s Rationing Experiment in a report by Peter Ferrara. It concludes that without the plan, Medicaid spending would have risen 25 percent in two years; with the plan, it will rise 65 percent. It also says the plan will increase the cost of medical care for insured working people, institutionalize cost-shifting and result in layoffs and business failures.

P.J.O’Rourke, author of Give War a Chance & Parliament of Whores, commented the morning after Clinton’s address: I watch the network news and discover that the plan can’t be summarized briefly. I read the papers and find the plan cannot be explained at length. I listened to the president himself and he seems at least as confused as I am, though less succinctly. I gather, from the president’s sales pitch, we’re supposed to come up with a large sum of money to invest in a vaguely described deal that’s going to have a huge payoff someday. Isn’t the FTC trying to crack down on people who do this sort of thing over the phone? We can be certain of some facts about the health-care reform plan. It won’t work. The president has put a lawyer in charge of making doctors cheaper. Federal health-care reform will drive the best people out of the health-care professions.

Thomas Sowell, of the Hoover Institute at Stanford, states that the president concedes that we already have the finest medical care in the world. Yet he is outraged that we spend more than other countries do. What is so surprising about the fact that the best costs more? You can always pay less and get less. But only by creating a massive new government program are you likely to pay more and get less.

People think the health care system needs fixing but aren’t sure of what’s broken according to a survey by the WSJ/NBC News.

Mike Royko in his column “The Hillary Plan: Watch your wallets” comments that Big Bro & Big Sis will probably pull it off. They have a big advantage in the media, since economists and doctors don’t know how to relay their message in 20-second sound bites. The genuine experts wind up on the opinion pages of a few big newspapers or in small magazines. For a preview of how the government will run health care, visit any VA hospital.

Also the Morning After. . . Diana Griego Erwin (Sacramento Bee) focused on the $40 Billion lost annually through billing errors. She estimates that would buy health insurance for 14 million Americans… Isn’t that about the number of uninsured that aren’t just between jobs?

Fifty years ago the emphasis of medical education was on primary care with the majority of medical students desiring that as their goal. The government emphasis on research through the national institutes of health and support of technology has gradually shifted the emphasis to specialty and subspecialty training programs with 85% of graduates in 1992 planning to go into such training. Now the government wants to reverse its own emphasis to again achieve a 50/50 split between specialists and primary care doctors. With the hundreds of billions spent by the government to develop the technology and emphasis and now the hundreds of billions the government plans to spend to de-emphasize the technology and reverse the emphasis, could we be so bold as to say that the normal course of events without government intrusion would probably have resulted in our being where the government currently wants us to be? Will we ever be able to learn from our past mistakes?

Despite these changes in emphasis, we should be proud of our own University of California. Over the past year as the UC system reviewed the specialty/primary care mix of their graduate training programs, they have looked to UC Davis as the model for the entire system. UCD leads the list in 1992-93 with 53% primary care residents, followed by UCLA with 47.5%, UCSF at 43.5%, UCI 42.6%, and UCSD at 31%. UCD emphasis continues with 66% of their graduates in primary-care residencies. Up from a 46% average from 1972-92. Congratulations to our professors across town.

The 77,000 member American College of Physicians gave qualified support to Clinton’s plan. All medical groups including the AMA support universal health coverage. All seem to want changes before full support can be given. The American Hospital Association and the American association of Retired Persons gave unqualified support as expected. The Federation of American Health Systems declines to give support. Dr. Koop, previous surgeon general, urged doctors to work for changes in the health system. “Our reservations or even outright objections, to some provisions cannot give us the excuse to oppose everything.”

The US Department of Education released a devastating report on illiteracy among adults and youth showing that one in four high school seniors has not reached even a basic reading proficiency.

Martin Feldstein, WSJ Board of Contributors, evaluates the proposed health plan on September 29, one week after it’s presentation. He estimates that financing the expanded health insurance benefits would cost about $120 billion more per year than the plan projects increasing marginal income tax rates by at least 24%. He recommends that Congress should be working on alternative lower-cost ways of dealing with our health care problems.

This Federal Health Plan Worked Too Well. Shackleford, in the Wall Street Journal, cautions before we OK any plan that attempts to increase access to health care while harnessing costs ought to re-examined the government-funded End-Stage Renal Disease program. It shows that per-treatment costs can be controlled by setting limits on what providers are paid, but controlling the volume is vastly more complex. The initial projection was to serve 11,000 people in renal failure with a program cost of $35 million to $75 million with increase to $250 million by 1977. First-year costs were $229 million and reach $1 BILLION in 1977. A 100% variation in initial estimates still produce a 300-400% error over initial projections and a 400% error over five year projections. Costs in 1991 were $6.6 billion. This occurred despite a cap in reimbursement, no compensation for inflation, and lowering the reimbursement rate twice. The program was designed for 11,000 people and today serves 165,000, and is projected to reach 300,000 beneficiaries soon. Before 1972, it was designed for people 25-55 years of age. Now the fastest growing segment are those over 65 with aged beneficiaries in a persistent vegetative state and nursing home residents who go to dialysis centers on stretchers. . . President Johnson’s projection of the initial Medicare premium was at a 560% error. . . At the usual 100-500% error, President Clinton’s payroll tax projection of 3.5-8% would easily end up being somewhere between 7% and 40% of additional payroll taxes over the current 8%. With Clinton’s income tax rate projected to go to 39%, state income taxes to 11%, plus sales tax on everything we buy of 7% and property tax on everything we own at over 1%, we should be getting close to the 84% that UK had when Michael Caine left his country or the 101% taxes that a Swedish author experience before he left his country. And we still haven’t balanced the budget.

What does the government consider free? Charles Osgood reports that one of our serious problems in this country is that the public has been conditioned to think when the government does something for them for no charge, it is free. Each cabinet member has 5-10 of their best employees dedicated to opening our mail and dealing with the responses. The Pentagon’s toll-FREE number since 1979 received 15,000 calls last year at a cost of $1.2 million. That works out to $80 per call. That’s 80 dollars per FREE CALL!