News Capsules (Summer
Medical Savings Account Availability Act
On April 4, 2001, Chairman Bill Thomas (R-CA) and Rep. William Lipinski (D-IL) introduced legislation to expand the eligibility for MSAs to more Americans and to make MSAs permanent.
"Summary of the Medical Savings Account Availability Act:
° Makes MSAs permanent. Last year, Congress extended MSAs for two years. However, many insurers are unwilling to invest the capital to market MSAs if they will expire shortly. Expands the eligibility of MSAs to all individuals with a qualified high deductible plan. Currently, MSAs are limited to small employers that have 2-50 employees. This provision allows any size company to offer MSAs and also allows individuals to purchase MSAs.
° Lowers the minimum deductible to $1,000/individual plan and $2,000/family plan. The lower deductible will be less intimidating to consumers who will be able to raise their deductible and save money on premiums over time as the funds in their MSA grow.
° Allows annual contributions to the MSA to equal 100 percent of the deductible. This will reduce out-of-pocket exposure for MSA holders by allowing them to more quickly reach their deductible with tax-free contributions. It also provides incentives to save more money in their MSA, which can later be used for long-term care.
° Allows both employers and employees to contribute to the MSA. This will help all MSA holders to more quickly fund their MSAs, limiting their out-of-pocket exposure and allowing build up of reserves for long-term care expenses.
° Encourages PPOs to offer MSAs. Currently, a qualified high deductible plan may cover preventive benefits mandated by state law. However, many PPOs offer first dollar coverage on non-mandated preventive care, as a marketing tool. This provision would encourage PPOs to sell MSAs and cover important preventive benefits.
° Allows MSAs to be offered by cafeteria plans. Offering MSAs under cafeteria plans will: (1) greatly expand the number of consumers that can be reached by MSAs; and (2) treat MSAs like other health plans.
° Repeals the 750,000 cap on taxpayer participation. Many insurers have been reluctant to offer MSAs because the cap limits the size of the market in which MSAs can be offered."
E-mail Monitoring and Cell Phone Tracking Eroding Personal Privacy
"The revelation of the FBI's Carnivore e-mail surveillance system has caused a debate over where to draw the line between public safety and an individual's privacy.
"Privacy groups want strict guidelines on what personal information the government can gather and retain.
° The FBI and the Justice Department insist Carnivore's purpose is to intercept only information it has a right to; but it may be impossible to guarantee untargeted citizens would escape government probing.
° Carnivore software has the "surgical ability" to spot and collect "to-and-from" information from the e-mail of a criminal target; however, the software scans all e-mails of a target to do this.
° The FBI claims it doesn't look at the subject line of the e-mails, but it is not known whether the software can exclude that information.
"Critics of Carnivore argue that federal agencies' current technology as well as new technologies such as the ability to track cell phone users will erode personal privacy. They contend these agencies currently gather information without a warrant that is constitutionally required.
"They are also skeptical of the FBI's promises not to overreach with Carnivore. In 1994 the FBI lobbied for the communications Assistance for Law Enforcement Act, contending it was only seeking to improve its abilities to conduct wiretaps in the age of computers and wireless communications. The FBI explicitly promised not to seek any more surveillance capability than it already had under existing law. However, the Act gave the FBI unprecedented authority to dictate wiretap-friendly technical standards."
(National Journal, Sept. 2, 2000.)
Medical Privacy Sources
° Cihak RJ. Big Doctor's New 'Privacy' Regulations, WorldNetDaily.com, March 19, 2001.
° Faria MA. AAPS: It's Time to Draw Line in the Sand on Medical Privacy, NewsMax.com, March 22, 2001.
° Vernon W. Medical Group: Regs Would Create National Database of Patient Records, NewsMax.com, March 28, 2001.
° Faria MA. Tossing Medical Privacy Out the Window, WorldNetDaily.com, April 16, 2001.
° Perry JL. Privacy Rules Open Door to Socialized Medicine, NewsMax.com, April 23, 2001.
Bush Administration to Create Database for Medical Errors
"The Bush administration is working to create an Internet-based clearinghouse of medical mistakes that doctors and hospitals make, trying to help them avoid such errors.
"Health and Human Services Secretary Tommy Thompson plans to announce a task force of department officials to develop the system, officials said.
"Health care pro-viders could use the Internet to report information to the federal government, or state and private-sector regulators.
"At least 18 states require health officials to report mistakes, and the federal government routinely collects voluntary information from hospitals for research...
"Researchers estimate that mistakes in surgery, medication and other services kill an estimated 44,000 to 98,000 people each year. Recent reports have suggested that computerized records could help doctors and hospitals keep better track of the things that go wrong...
"Some in Congress have suggested that they would not oppose a national information system.
"The administration has said there is no move to mandate use of a medical error-reporting system.
" 'We can make much better use of information we already collect, and we can translate that...into quality gains for patients,' Thompson said.
"The system envisioned by HHS is not unheard of in other fields. The airline industry, for one, reports errors to a common site and the information is used to alert pilots to the mistake so they will avoid doing the same thing.
"President Bush is asking Congress for $12 million in start-up money for the medical error-reporting system.
(Miami Herald, April 23, 2001)
Day Care Children and Behavioral Problems
"A new study concludes children who spend most of their time in child care are three times as likely to exhibit behavioral problems in kindergarten than those who are cared for primarily by their mothers.
"A National Institutes of Health study, which is yet to be published, is widely regarded as the most comprehensive examination of child care to date.
° The study found a direct correlation between time spent in child care and traits such as aggression, defiance and disobedience.
° Development of such traits held true regardless of the type or quality of care, the sex of the child, the family's socioeconomic status or whether mothers themselves provided sensitive care.
° Jay Belsky, one of the study's principal investigators, said children who spent more than 30 hours a week in child care 'are more demanding, more noncompliant, and they are more aggressive' - adding that they score higher on categories such as getting in lots of fights, cruelty, bullying, meanness and talking too much.
° While the re-searchers do not yet have an explanation for the pattern, they theorize that child care providers are not trained to give emotional support, or perhaps parents are overworked.
"They stressed that the children's demands and aggressions were 'in the normal range' and not so severe as to require medical attention."
(New York Times, April 19, 2001)
Junk Science Awards
Prince Charles of Britain, PETA, NY Times, and the state of California are among the winners of an annual award recognizing the ways in which people are frightened by junk science.
"The Chicken Little Awards, created 11 years ago by the New Jersey-based National Anxiety Center, were awarded in April with California receiving the top award for 'doing nothing for the past decade to provide electrical energy, despite the growth of its population,' said Anxiety Center Founder Alan Caruba. 'Their desire to protect the environment has literally left the environment in which people live and work in the dark.'
"Britain's Prince Charles was recognized for his opposition to genetically engineered food products. 'The prince and the radical environmental organization, Greenpeace, ignore the need to feed six billion people every day,' said Caruba, who noted that Charles 'has been dining royally since the day he was born.'
" 'We are drowning in junk science...' said Caruba. Other Chicken Little Award recipients included the New York Times for publishing and then retracting a story about the melting of the North Pole..."
(CNSNews.com, April 9, 2001)
Drug Treatment or Surgery?
"To reduce the cost of treatment, health care providers have turned increasingly to drug treatment as a less expensive alternative to surgery. However, some surgical costs have been reduced by using less invasive and therefore less risky surgical procedures that require less time for recuperation. And sometimes surgery is more effective than drug treatment.
"For instance, balloon angioplasty is a procedure increasingly used to reopen clogged arteries, rather than more invasive surgery using grafts to bypass clogged arteries supplying the heart. However, a significant percentage of patients who would benefit from balloon angioplasty or bypass surgeries do not receive them, and suffer as a result, British researchers report in the New England Journal of Medicine.
° Using an expert panel to evaluate patients, researchers found that 26 percent of 1,353 people in the study who should have received bypass surgery got drug treatment instead.
° As a result, they were four times more likely than surgery patients to die or have a heart attack, and they were three times more likely to have chest pain years later.
° 34 percent of those who should have received the balloon procedure to reopen their arteries did not receive that procedure.
° As a result, the latter were twice as likely to have continuing chest pain.
"An editorial in the same issue notes that data from well-insured populations in the U.S. show similar levels of underuse."
(USA Today, March 1, 2001; New England Journal of Medicine, March 1, 2001, http://nejm.org/content/2001/0344/0009/0645.asp; NCPA Policy Digest, March 1, 2001.)
Waiting Lists in Ireland
"An eight year, multimillion pound campaign to reduce hospital waiting lists in the Republic of Ireland's public health service has been largely unsuccessful, reports the British Medical Journal. Although lists overall have shown a small decline, many patients are waiting longer now than four or five years ago.
"Waiting lists are a form of health care rationing in national health systems that provide care largely free of cost to patients.
° The Irish government has managed to reduce waiting times in only three adult specialties: cardiac surgery, vascular surgery and ophthalmology.
° Waiting times for pediatric cardiac surgery have decreased, but 60 percent of such patients still wait for more than six months.
° Indeed, the Eastern Regional Health Authority has just told the children's hospital at Crumlin, in Dublin, that if it cannot provide urology surgery for children in need, it must send them abroad for care.
"Regarding access to care, patients living outside Dublin remain as disadvantaged in their access to medical specialists as they were 10 years ago. Nearly one in two consultants and junior doctors are in Dublin --- even though three quarters of the population do not live in the east of Ireland."
(British Medical Journal, March 24, 2001, http://bmj.com/cgi/content/full/322/7288/694/a; NCPA Policy Digest, March 23, 2001.)
Death Rates From Guns Decline
"Fewer Americans are being killed or injured in gun-related incidents, according to data from the Centers for Disease Control and Prevention.
"The death rate declined 26 percent between 1993 and 1998 --- and the injury rate fell by nearly half. The death rate hit its lowest point since 1966.
° CDC figures put gun-related deaths at 30,708 in 1998 --- and injuries at 64,484.
° That's 11.4 deaths per 100,000 population --- and 23.9 injuries per 100,000.
° Of particular concern, the CDC said, was the striking rate of gun suicides among elderly men --- an average of 27.7 per 100,000 over the five-year period.
° For women, the rate was 1.8 per 100,000 for those over 65.
"Analysts predicted that incidents of suicide among the elderly will only increase as the population ages. Men were victims of five of every six gun deaths and seven out of every eight gun-related injuries during the five-year period.
"Guns remain the second leading cause of injury-related deaths in the United States, trailing only auto accidents."
(Washington Times, April 13, 2001)
Canada's Firearms Registry
"Canada's controversial firearms registry requires all gun owners to be licensed by January 2001, and all firearms registered by January 2003.
"However, the registry has experienced huge cost overruns and has negative consequences for all Canadians' individual freedoms, says a new study by Canada's Fraser Institute.
° The federal government claimed it would cost no more than $85 million (CDN) over five years to implement firearm registration --- but the cost of setting up the registration bureaucracy has already passed $600 million and is expected to reach $1 billion in 2001.
° The number of employees working on firearm registration grew from under 100 in 1995 to over 1,700 in the year 2000; meanwhile, the number of police officers in Canada has declined by over 10 percent since 1975 on a per capita basis.
° The ratio of police officers to population is at its lowest point since 1972.
"Although polls find over 80 percent of Canadians support registering firearms, public opinion shifts when people realize it will cost them, as taxpayers, a significant amount of money, or that it will divert government resources from more desirable programs. Support drops to 50 percent when respondents are told it might cost $500 million to register firearms; it drops to around 40 percent when the trade-off is a reduction in the number of police officers.
"Canada has adopted several increasingly restrictive firearm laws, either restricting access to firearms, or prohibit-ing and confiscating arbitrary types of ordinary firearms. But there is no evidence they have actually reduced violent crime."
(Public Policy Sources No. 48, March 2000, Fraser Institute, Vancouver, BC, http://www.fraserinstitute.ca/publications/pps/48/index.html)
Compassion in Dying Of Oregon
Under the Act Compassion in Dying of Oregon, those patients in 2001 who will be using Oregon's assisted dying law will be no different from those of the year 2000.
Of all Compassion in Dying of Oregon's clients in 2000, only 21 terminally ill people chose to use Oregon's assisted dying law, three more than last year.
"Other statistics are also little changed from last year. All 21 had health insurance, and 17 were receiving hospice care. Ten were males, 11 were females. For the third year in a row, loss of autonomy topped the reasons people gave for using Oregon's law, cited by all 21 patients. Fear of loss of control was also listed by nearly all patients. All 21 had a long held belief in assisted dying. All died with a loved one or close friend present. All were Caucasian...
"While there were no complications in taking the medications, in one case, one of two witnesses neglected to sign a form after witnessing the patient's desire for a hastened death. The signature was obtained after the patient died...
" 'The option of a dignified, hastened death gives terminally ill people the hope and comfort to carry on,' said Barbara Coombs Lee, president of Compassion in Dying Federation. 'Many more people request access to Oregon's law than actually use it. That important part of the law's history hasn't been told. It helps far more people than those who ultimately hasten their deaths,' she added."
(U.S. Newswire, Feb-ruary 20, 2001)
"A euthanasia advocate wants to anchor a ship off the Australian coast and offer to kill terminally-ill patients.
"The floating execution chamber will offer so-called 'death with dignity' to incurably ill patients if an Australian doctor has his way.
"Dr Philip Nitschke, a long-time euthanasia campaigner wants to anchor the death ship beyond Australia's territorial limits where patients would be killed by lethal injections or drug overdoses.
"Because euthanasia is illegal in Australia, Dr. Nitschke plans to get around his country's ban by buying a ship registered in the Netherlands where the Dutch senate was posed to legalize euthanasia.
" 'If this was a Dutch-registered vessel, it would be possible legally to provide access to voluntary euthanasia in international waters,' Nitschke said. 'That's the proposal, that we get such a ship and provide assistance to people who would take such an opportunity if such a service existed. I see people all the time and I know that (they) would access it if it was there.'
"The idea is an extension of Dutch doctor Rebecca Gompert's plan to launch a baby-killing ship and anchor it off the coasts of nation's where abortion is illegal."
(NewsMax.com, April 10, 2001)
Columbia University Awards Coveted Bancroft Prize to Controversial Author
"Columbia University bestowed its Bancroft Prize, an award it touts as 'one of the most prestigious awards in the field of history,' upon Michael Bellesiles of Emory University, author of last year's Arming America: The Origins of a National Gun Culture. Bellesiles's book, according to the author, is a culmination of research that indicates that most Americans around the time of our country's formation did not own firearms. This, of course, is contrary to reams of scholarly research showing that America has always been a nation where the possession of firearms by responsible, law-abiding citizens has been widespread...
"An editorial by Kimberley Strassel from the April 5 issue of The Wall Street Journal points out that Bellesiles's research has been under fire by many respected scholars. Thus far, however, Bellesiles has refused to produce anything of substance that would counter the claims of his critics. Gerald Rosenberg, a visiting professor of law at Northwestern, told Strassel, "...[T]he evidence is so overwhelming that it is incumbent upon Bellesiles as a serious scholar to respond. He either has to admit error, or somehow show how his work is right."
"UCLA law professor Eugene Volokh has pointed to examples of Bellesiles either misquoting sources, or citing sources that do not contain the information the Emory professor claims they contain...
"And Northwestern professor of law James Lindgren tackles what many reviewers have considered to be the most compelling aspect of Bellesiles research --- his use of probate records, which are basically inventories of someone's estate at his time of death. Bellesiles claims his research shows that only 14.7 percent of American men, and virtually no women, owned firearms, and he goes on to claim that most guns were old or broken. But Lindgren says he went over the same records that Bellesiles cited, and found that 54 percent of American men, and 18 percent of the women, owned firearms, with no indication that most were listed as old or broken. Lindgren stated, 'No one who has seen the evidence can figure out how he could have made such errors, or why he has not retracted the obviously mistaken data.'
"According to Strassel, Bellesiles told her that many of his critics are 'ideologically motivated,' but she points out that Rosenberg and Lindgren all told her that they favor gun control. Bellesiles has also revealed that he did not keep a database (rather odd in the age of computers), but kept all his data on paper notes, and he claims these paper notes were recently destroyed in a flood. Randolph Roth, an associate history professor at Ohio State who also supports gun control, examined Lindgren's work on probate records and commented that 'it looks as though Mr. Bellesiles work won't be reproducible.' "
(NRA-ILA Fax Alert, Vol. 8, No. 15, April 13, 2001)
Reviewing Bellesiles' book for Ideas on Liberty, Clayton Cramer, author of Concealed Weapon Laws of the Early Republic: Dueling, Southern Violence, and Moral Reform (Praeger Press, 1999), reveals that Bellesiles' reason for writing the book is "to destroy the rationale for the Second Amendment."
Bellesiles "mischaracterizes what his sources say...When I started checking his sources for the more amazing claims, I found that they didn't check out...He quoted sources out of context and then inaccurately reported what the rest of the sentence said. In many cases, none of his sources matched his claim," writes Cramer.
(Ideas on Liberty, January 2001, pp. 23-27)
Russia Struggling With Private Property
"Perhaps it's because for seven decades Russians were forbidden to own private land, but now that they are allowed to do so many are scared to make the move.
"A rural area 500 miles from Moscow was the first region to adopt a land-ownership law after the new Russian constitution, adopted in 1993, guaranteed that 'the right of private property shall be protected by law.' But mere permission to buy and sell land has not turned out to be enough.
° Without a viable banking and legal system, the vast majority of Russian farmers prefer to continue leasing land from the government at cheap prices - wary that they won't be able to keep what they do buy.
° Their fears may be justified, because old-school leftists who are still in power are resisting any changes which could transfer land to private hands --- which defeated former President Yeltsin's efforts to privatize rural lands.
"Sales of urban lands are not as controversial as farm sales. Without a workable land code, grain production has fallen by half since 1992."
(Washington Post, March 25, 2001. For more on Russia, see http://www.ncpa.org)
This edition of News Capsules was compiled by Miguel A. Faria, Jr.,
M.D., Editor-in-Chief of the Medical Sentinel of the AAPS. It appeared
in the Medical Sentinel 2001;6(2):40-44. Copyright©2001 Association
of American Physicians and Surgeons (AAPS).