MEDICAL TUESDAY . NET
Community For Better Health Care
Vol XIII, No 2, May, 2014
In This Issue:
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The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 12th Annual World Health Care Congress will be held March 23-25, 2015 at the Marriot Wardman Park Hotel, Washington DC. For more information, visit www.worldcongress.com. The future is occurring NOW.
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1. Featured Article: Is Disability Contributing to Women’s Declining Employment?
Women's labor force participation rate (LFPR) - the percentage of individuals employed or looking for work - reached an all-time high of 60 percent in 1999, but since then has steadily declined to 57.2 percent in 2012.
Men's labor force participation has been dropping for decades, yet still remains higher than women's. Some analysts note that an increasing number of married women have decided a career is not worth it and are opting to stay at home. Others point to the much lower participation rate of younger women (under age 24) than older women. Still others attribute the overall decline among both men and women to baby boomers entering retirement.
Though the labor force participation of women is now the lowest in more than 10 years, record numbers are receiving Social Security disability benefits. Could these two trends be related? Read more . . .
Disability Rolls for Women versus Men. Increases in disability rates were expected as the share of the workforce comprised of women grew and more women worked long enough to obtain the minimum three years of credits required to qualify for Social Security disability. In fact:
· In 1970, women comprised about 28 percent of workers receiving Social Security disability benefits.
· By 2000, when women's labor force participation started falling, the portion of women receiving disability had increased to 43 percent.
· In 2012, almost half (48 percent) of the 8.8 million workers receiving benefits were women.
· By 2000, when women's labor force participation started falling, the portion of women receiving disability had increased to 43 percent.
· In 2012, almost half (48 percent) of the 8.8 million workers receiving benefits were women.
The recent growth in female disability beneficiaries has been comparable to men's. . .
Younger Women Are Receiving Disability. A growing trend is that an increasing number of younger women are receiving disability awards. From 2000 to 2012, men outnumbered women in benefits awarded overall. However:
· In six of the last 12 years, more women ages 35 to 39 were awarded benefits than men.
· In eight of the last 12 years, more women ages 30 to 34 were awarded benefits than men.
The majority of disability claims growth has been among men and women over the age of 50. But the growth of younger females beneficiaries is a concern. Most individuals receiving disability benefits do not work, though recipients can earn up to $770 a month without losing benefits. However, the chances of recipients ever leaving the disability program and returning to full-time work are less than 1 percent. For women in their 30s, this means their careers are short-lived.
The Leading Causes of Disability. In 2000, the leading cause of disability among male and female workers of all ages was musculoskeletal disease [see Figure I]. It remains the leading cause today. Musculoskeletal diseases are conditions that affect muscles, bones, ligaments and tendons. They include but are not limited to rheumatoid arthritis, bursitis, carpal tunnel syndrome, tendonitis and fibromyalgia. Some musculoskeletal disorders are directly linked to work-related injuries. Consider [see the figure]:
· About 13.2 percent of women and 11 percent of men under age 35 awarded disability benefits were diagnosed with a musculoskeletal condition; in 2012, women under 35 still outpaced men in this category.
· For disability recipients ages 35 to 49, one-fourth of the women were diagnosed with a musculoskeletal condition in 2000 compared to one-third of the men; but the percentage of women with these disorders jumped to more than 30 percent by 2012.
· The largest increase in awards was in the 50 and older age group. Nearly 34 percent of women were diagnosed with musculoskeletal disorders in 2000 compared to 29.9 percent of men and, by 2012, the percentage of recipients of both sexes with these conditions had increased 10 percentage points.
In 2000, mental disorders (excluding mental retardation), were the second leading cause of disability for women and men, comprising 23.5 percent of awards. For women 50 and over, disability due to mental disorder diagnoses increased from 11.6 percent in 2000 to 14.2 percent in 2012, but fell about 3 percentage points for men.
The Affordable Care Act and Mental Health. A major requirement of Obamacare is to treat mental disorders on par with physical illnesses:
· Insurers can no longer cancel or deny coverage to individuals based on pre-existing mental or emotional disorders, such as depression.
· There are no lifetime limits on benefits for mental disorders or limits on the number of treatments. . .
If these trends continue, disability that prevents work may become a greater issue for young women than the social and economic factors that apparently inhibit their advancement in the work force.
Pamela Villarreal is a senior fellow with the National Center for Policy Analysis.
Read the entire analysis at http://www.ncpa.org/pub/ba797
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2. In the News: Your total assets are truly amazing.
By Jack Hough | WSJ | May 11, 2014
When you hear the word investment, you probably think of your home, stocks and mutual funds, your retirement account, maybe your baseball-card collection. But how often do you think of your job?
You should, because for all but the wealthiest, your job is probably your No. 1 investment. Just think of your wages as the equivalent of a portfolio's income stream. The median household income in the U.S., about $51,000, equals the income of a stock-and-bond portfolio worth more than $1.2 million—assuming sustainable withdrawals of 4% a year.
Most U.S. households don't have anything close to $1.2 million saved. Among households with financial assets like stocks and bank certificates of deposit, the median portfolio was barely $30,000 as of 2010, according to Federal Reserve data. Or, to put it in corporate accounting terms, most Americans are all income statement and no balance sheet. Read more . . .
So while everyone should learn the basics of investing, most workers should treat their ability to earn and save as their biggest asset. With that in mind, here are some hot investments that you probably don't think of as investments. But for most households, they matter more for growing wealth than the fine details of portfolio management.
1. Your benefits.
There are many ways to save, but for typical families, one seems to be working better than others. Between 1989 and 2010, the share of household financial assets held in retirement accounts nearly doubled to 38%, according to the Federal Reserve.
Not coincidentally, the number of active 401(k) participants has also ballooned, from 7.5 million in 1984 to 73.7 million last year. Few savings vehicles can match the 401(k) on features that promote long-term success. Workers typically add money automatically from their pay and get a tax break on their contribution, plus, more often than not, a matching contribution from their employer.
Even a middling 401(k) experience can pay off handsomely. A Congressional Research Service study in 2007 projected that a median-income household could stash away $468,000 after inflation in a retirement account by age 65 simply by starting at age 35, contributing 8% of pay and earning typical stock and bond returns. . .
Group life insurance can be a money saver too. . . Also, don't forget health insurance, tuition reimbursement, corporate travel discounts and credit unions.
Then there's Social Security, which is basically like a lifetime annuity from an insurance company. Some couples retire with Social Security income equivalent to that generated by investments worth over $1 million.
2. Your body.
Workers who exercise regularly earn 9% higher pay, on average, than those who don't, according to a 2012 study published in the Journal of Labor Research.
By scoring subjects on their propensity to exercise, based on factors like age, education level and school sports involvement, the study showed a cause-and-effect relationship between working out and earning more. Other studies have documented an obesity penalty to earnings, which seems to hit women hardest.
The financial benefits of fitness extend well beyond earnings. The fit pay less for life insurance than the fat, and spend less on health care.
Plus, the benefits to employers of worker fitness—fewer sick days, higher productivity and so on—are enough to make companies want to chip in.
Put it all together, and for a typical household the return on investment for getting in shape over the next year dwarfs the likely gains from financial assets
3. Your marriage.
Married couples gain financial leverage by sharing things like expenses, assets and health-care coverage. As a result, they increase wealth by 4% a year simply as a result of being married, according to a 2006 study by the Center for Human Resource Research at Ohio State University.
For couples who divorce, the same study found, wealth a decade later is three-quarters lower than for couples that remain married.
Considering the stakes, unhappy couples should view $100 a pop for weekly visits to a marriage counselor as a wise investment.
4. Your spending.
Small savings here and there can add up to meaningful wealth come retirement, for those who start early. For each $5 trimmed from daily expenses and invested at 6% yearly returns, the result after 40 years is nearly $300,000.
Discovering that $5 starts with tracking expenses, but fewer than one in three Americans prepares a detailed budget, in writing or on a computer that tracks income and expenses each month, according to a Gallup poll last year.
For the other two thirds, creating a budget can generate an extraordinarily high return on investment. Some personal-finance sites, such as Mint.com, are free and automatically download information from financial institutions. . .
5. Your community.
Homes are the biggest nonfinancial asset for most households, and 70% of home-owning households have a mortgage. The median amount was $112,000 in 2010. That means that, since location is a key determinant of home values over time, many households are making a leveraged bet on the health of their communities.
Unlike with stocks, a little market manipulation here is encouraged. Show up for the Saturday school cleaning. Press the town to fill in nearby potholes. Help a sick neighbor mow her lawn.
Worst case, your efforts bring only personal satisfaction. Best case, others follow your lead and gradually increase neighborhood home values.
Write to Jack Hough at firstname.lastname@example.org
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Avik Roy , Forbes Staff
GUEST POST WRITTEN BY Jason Clemens and Bacchus Barua
Mr. Clemens is the executive vice-president and Mr. Barua is
senior health economist at the
Fraser Institute in Canada.
The heated and often emotionally charged debate over the Affordable Care Act (aka Obamacare) hasn’t subsided despite it being the law of the land for more than four years. Indeed, with the VA scandal, continuing problems in the rollout of aspects of Obamacare and the upcoming mid-term elections, the likelihood of increased acrimony is high.
One aspect of the health care debate in the United States that is, unfortunately, riddled with misinformation is the state of Canada’s single-payer health care system. Too often advocates of Canadian-style health care in the U.S. present limited or even misleading information about the true state of Canada’s health care system and worse, often times present the ideal of Canadian health care rather than its reality. Read more . . .
It’s first important to recognize that a single-payer model is not a necessary condition for universal health care. There are ample examples from OECD countries where universal health care is guaranteed without imposing a single-payer model.
Amongst industrialized countries — members of the OECD — with universal health care, Canada has the second most expensive health care system as a share of the economy after adjusting for age. This is not necessarily a problem, however, depending on the value received for such spending. As countries become richer, citizens may choose to allocate a larger portion of their income to health care. However, such expenditures are a problem when they are not matched by value.
The most visible manifestation of Canada’s failing health care system are wait times for health care services. In 2013, Canadians, on average, faced a four and a half month wait for medically necessary treatment after referral by a general practitioner. This wait time is almost twice as long as it was in 1993 when national wait times were first measured. . .
Long wait times in Canada have also been observed for basic diagnostic imaging technologies that Americans take for granted, which are crucial for determining the severity of a patient’s condition. In 2013, the average wait time for an MRI was over two months, while Canadians needing a CT scan waited for almost a month.
These wait times are not simply “minor inconveniences.” Patients experience physical pain and suffering, mental anguish, and lost economic productivity while waiting for treatment. One recent estimate (2013) found that the value of time lost due to medical wait times in Canada amounted to approximately $1,200 per patient.
There is also considerable evidence indicating that excessive wait times lead to poorer health outcomes and in some cases, death. Dr. Brian Day, former head of the Canadian Medical Association recently noted that “[d]elayed care often transforms an acute and potentially reversible illness or injury into a chronic, irreversible condition that involves permanent disability.”
New research also suggests that wait times for medically necessary procedures may be associated with increased mortality. A recent report concluded that between 25,456 and 63,090 Canadian women may have died as a result of increased wait times between 1993 and 2009. Large as this number is, it doesn’t even begin to quantify the possibility of increased disability, poorer quality of life, and mental stress as a result of protracted wait times.
As Americans struggle with determining the next steps for health care reform, whether that means continuing to tweak the ACA or “repealing and replacing it,” they should keep in mind that the success of any reform depends in part on the degree to which facts dominate fiction and ideology. Discussion of the Canadian model is worthy of inclusion in such a debate, but more in terms of “what to avoid” than as a model for reform. The reality of Canadian health care is that it is comparatively expensive and imposes enormous costs on Canadians in the form of waiting for services, and limited access to physicians and medical technology. This isn’t something any country should consider replicating.
Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35,  1 S.C.R. 791
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4. Medicare: And Other Government Programs: War On Poverty
By John Goodman | Health Alerts | May 7, 2014 –
Take a look at the graph below. From the end of World War II until 1964 the poverty rate in this country was cut in half. Further, 94% of the change in the poverty rate over this period can be explained by changes in per capita income alone. Economic growth is clearly the most effective antipoverty weapon ever devised by men. The dotted line shows what would have happened had this trend continued. Economic growth would have reduced the poverty rate to a mere 1.4% of the population today ― a number so low that private charity could probably have taken care of any unmet needs. But we didn’t continue the trend. In 1965 we launched a War on Poverty. And as the graph shows, in the years that followed the portion of Americans living in poverty barely budged. In 1965, 18% of the population lived in poverty. Today we are at 15%, or 50 million Americans. That’s after spending $15 trillion on antipoverty programs and continuing to spend $1 trillion a year. Read more . . .
Now here is something you may not know. Early on ― in the first decade of our 50-year experiment with an expanded welfare state ― carefully controlled experiments funded by the federal government established without question that welfare changes behavior. It leads to the very behavioral changes that keep people in a state of poverty and dependency. Think about that. Any serious social science debate about the effects of welfare on the behavior of the recipients was resolved four decades ago! We now know a lot about how behavior affects poverty. In fact, if you do these four things, it’s almost impossible to remain poor: Finish high school, Get a job, Get married, and Don’t have children until you get married. So how does welfare affect behavior? In the late 1960s the federal government sought to find that out in what Charles Murray calls “the most ambitious social science experiment in history.” The experiments were all conducted by social scientists that believed in the welfare state and had no doubt about its capacity to be successful. In other words, they were confident of the answers before the experiments ever began. Their goal was to prove that popular wisdom was all wrong ― that welfare would not cause people to reduce their work effort, to get married less often, divorce more quickly or engage in other dysfunctional behavior. The experiments were all controlled. Randomly selected people were assigned to a “control group” and an “experimental group.” The latter received a guaranteed income, and the program even used Milton Friedman’s term for it: a negative income tax. The largest, longest and best-evaluated of these experiments was SIME/DIME (Seattle Income Maintenance Experiment/Denver Income Maintenance Experiment) in Seattle and Denver. And the results were not pretty. To the dismay of the researchers, they largely confirmed what conventional wisdom had thought all along. As I reported in “Privatizing the Welfare State“: The number of hours worked dropped 9% for husbands and 20% for wives, relative to the control group. For young male adults it dropped 43% more. The length of unemployment increased 27% among husbands and 42% for wives, relative to the control group. For single female heads of households it increased 60% more. Divorce increased 36% more among whites and 42% more among blacks. (In a New Jersey experiment, the divorce rate was 84% higher among Hispanics.) BTW, these results have been studied and studied over and over again and there is a large literature on them ― almost all of it written by researchers who detested the outcomes. Good summaries are provided by Charles Murray and Martin Anderson. Both authors point out that the results are even worse than they appear at first. For one thing, the “control group” had access to conventional welfare available in the 60s and 70s. So this was by no means a pure (welfare free) control group. Also, the enrollees were given different instructions about how long they could expect their guaranteed income to last. It turns out that the longer the guarantee, the worse the negative effects. So far as I can tell there was no marriage penalty in these experiments ― certainly nothing like we have today ― and little or no penalty for earning a higher income. With the passage of time all these incentives have become increasingly more perverse. For example, over the past 50 years we have added one marriage penalty after another to welfare benefits. There is a very strong marriage penalty in ObamaCare, for example. And even Paul Krugman concedes that the marginal tax rate faced by low-income families is in excess of 80% today. (It actually goes above 100% in many cases.) And ObamaCare will make the penalty for working and earning even higher. So here is the important public policy question: If it is well established that self-sufficiency is closely related to working and being married, why are we “fighting poverty” by doing things that social scientists have known for decades lead to less work and fewer marriages? And here is a public discourse question: Why are New York Times columnists Paul Krugman and Nicholas Kristof declaring the War on Poverty a success when it is so obviously a failure? Both columnists claim that if we count goods-in-kind (food stamps, housing, Medicaid, etc.), the actual poverty rate would be lower by one-third. Of course, if we give people enough stuff and count it as income, we could declare victory and claim that there is no more poverty. Dylan Matthews makes much the same point that Krugman and Kristof make. After citing a Columbia University study on the different ways of measuring poverty, he zeroes in on the key point (how much difference does government make?) and says this: …[T]he most noticeable trend here is that the gap between before-government and after-government poverty just keeps growing. In fact, without government programs, poverty would have actually increased over the period in question. Government action is literally the only reason we have less poverty in 2012 than we did in 1967. Reviewing some of the early literature, I find it very difficult to determine what Lyndon Johnson would have called “success” in the War on Poverty. But there is no doubt in my mind what the average citizen thinks success is. The goal is to have people earning enough and saving enough to support themselves above a poverty level income without any help from government. So by that measure, there has been no progress at all ― despite spending $1 trillion a year on the effort. - See more at: http://healthblog.ncpa.org/why-we-lost-the-war-on-poverty/#sthash.oKZ8tgWI.dpuf
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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5. Medical Gluttony: How to use the ICD & CPT codes to avoid prosecution and possibly prison
CPT: Medical Coding Roundtable: Why 99214 Is Your New BFF
Code 99214 ranks as the second highest level of care for established patients, yet stands as one of the most underutilized codes out of the CPT book.
It is commonly thought that physicians may down-code to a 99213, if the physician is not sure their documentation supports a level 4 established patient visit. They leave a lot of money on the table that they are legitimately entitled to, if they just understood some simple basics that support a 99214.
There are several possibilities that could lead a provider to under-code a 99214. They are as follows:
Dollars and Sense (99214’s BFF Qualifications)
Some studies have indicated that aggregately, 37.3% of internists use 99214 for established patients. That is not a high number of providers utilizing this code, especially when the 2012 national Medicare (CMS) reimbursement for this visit is approximately $104. In other words, that’s a lot of money being left on the table due to fear or misunderstanding of how to properly code 99214.
Mind Your Minutes
Providers must remember that time is also a factor when it comes to coding to a higher level. Once the decision has been made to code a 99214, be mindful of the time spent with the patient. If the provider spends at least 25 minutes with the patient with more than half the time involved with counseling or coordination of care, 99214 is appropriate to code.
NOPP – Nature of the Presenting Problem
As with all high level codes, the provider must bear in mind that the presenting problem must be of moderate to high severity for a 99214. As long as the documentation of the presenting problem is consistent with medical necessity (which is the overarching criteria for code selection), the next step is ensure that the documentation is bulletproof, in the event of an audit. It is essential that the provider thoroughly and accurately documents each step of the visit to support the code being billed.
Documenting all diagnosis codes/problems discussed during the visit is a good way to ensure and support medical necessity for coding a 99214 (or any high level code).
Making 99214 Your BFF
CPT 4 defines 99214 as an “office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components”:
With that being said, documenting a 99214 is relatively simple. Since CPT 4 says that only two out of three key components must satisfy the documentation requirements for any particular level of care. It is up to the provider decide which elements to document, as the amount of required documentation is quite simplistic.
Step right up and get TWO of THREE (History, PE, MDM) to code for 99214. Some providers may find it easier to get to a 99214 by working in reverse through the elements to establish moderate MDM by documenting a combination of the following:
o OR 2 or more STABLE chronic illnesses. Yes, STABLE
o OR 1 chronic illness with progression or side effect of treatment
Key Points to Remember for 99214
Apply 99214 for any of the following:
The take-away from this lesson is that 99214 can be every provider’s BFF by keeping the following in mind: remember to take the time to quantify the MDM in the required documentation so that your record is bulletproof and supports your 99214.
Medical Gluttony thrives in Government and Health Insurance Programs.
It Disappears with Appropriate Deductibles and Co-payments on Every Service.
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6. Medical Myths: Increasing Minimum Wages would help our Welfare/Medicaid patients.
Most of the Benefits of a Minimum Wage Increase Would Not
Go to Poor Households
by David R. Henderson | March 12, 2014
Research Fellow, Hoover Institution, Stanford University
National Center for Policy Analysis
Health, Education, Labor, and Pensions Committee
United States Senate
I welcome the opportunity to share my views and research findings on proposals to raise the minimum wage.
Most people who earn the minimum wage or slightly more are the only earners in their households and, therefore, are poor, right? And so, if the federal government or state governments raise the minimum wage, that will be a nicely targeted way of helping poor people, right?
Well, no. Wrong on both counts. Most workers earning at or close to the minimum wage are not the sole earners in a household and most of them are not in poor households. For those two reasons, raising the minimum wage is not a targeted way to help poor people. Read more . . .
From 2003 to 2009, the federal hourly minimum wage rose in steps from $5.15 to $5.85, and then from $6.55 to $7.25. Between 2003 and 2007, 28 states increased their minimum wages to a level higher than the federal minimum. San Diego State University economics professor Joseph J. Sabia and Cornell University economics professor Richard V. Burkhauser examined the effects of these increases and reported their results in the prestigious Southern Economic Journal.1 They “find no evidence that minimum wage increases between 2003 and 2007 lowered state poverty rates.” Further, they calculated the effects of a proposed increase in the federal minimum wage to $9.50 on workers then earning $5.70 (or 15 cents less than the minimum in March 2008) to $9.49.
They concluded that increasing the minimum wage from $7.25 to $9.50 per hour “will be even more poorly targeted to the working poor than was the last federal increase from $5.15 to $7.25 per hour.”
Specifically, they found that if the federal minimum wage were increased to $9.50 per hour [see the table]:
Only 11.3 percent of workers who would gain from the increase live in households officially defined as poor.
A whopping 63.2 percent of workers who would gain were second or even third earners living in households with incomes equal to twice the poverty line or more.
Some 42.3 percent of workers who would gain were second or even third earners who live in households that have incomes equal to three times the poverty line or more.
They reached their conclusions by carefully examining U.S. Census data on household incomes and wages reported in the Current Population Survey. Thus:
The net increase in wage income to households containing low-wage workers would be $4.03 billion per month.
Monthly gains to households if there are 1,402,000 job losses (higher estimate) $287 million $2.63 billion
The net increase in wages to poor households containing low-wage workers would be only $439 million per month.
Moreover, note Sabia and Burkhauser, an estimate of gains in income to households with low wage workers necessarily overstates those gains if it does not take account of one of the well documented effects of the minimum wage: it destroys low-wage jobs. For over 60 years, economists have been aware that increases in the minimum wage cause some low-wage workers to lose their jobs. The reason: at a higher wage, the value of their output per hour (productivity) is not high enough for employers to gain by hiring them.
When they take this job-loss effect into account, Sabia and Burkhauser conclude that an increase in the minimum wage will be even less effective at reducing poverty. A low-end estimate of the reduction in jobs due to an increase in the minimum wage is that a 10 percent increase would reduce the number of low-wage jobs by only one percent. Economists refer to this as an elasticity of 0.1 (1 divided by 10). But even in this best case, they found that an increase to $9.50 per hour would destroy 468,000 jobs. This means that the benefits of a higher minimum wage to households containing low-wage workers would be even lower than their original estimates. . .
Another reasonable estimate from earlier studies is that a 10 percent increase in the minimum wage would destroy 3 percent of low-wage jobs, an elasticity of 0.3. If that estimate is correct, increasing the minimum wage to $9.50 per hour would destroy 1.4 million jobs. If that job destruction occurs, the net benefit to households containing low-wage workers would be only $2.63 billion per month, of which only $287 million would be a gain to households in poverty . . .
I thank you for your time and appreciate the opportunity to submit our views on this important question. I am pleased to offer any assistance we might give to help solve this significant public policy problem.
David R. Henderson
Research Fellow, Hoover Institution, Stanford University
Medical Myths originate when someone else pays the medical bills.
Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.
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7. Overheard in the Medical Staff Lounge: What is a doctors biggest challenge? Obstacle?
Dr. Rosen: What are the biggest challenges we face?
Dr. Edwards: Drowning in the minutiae of life. The things we have to do that don’t help us, our patients, society, or the cost of healthcare.
Dr. Ruth: That’s an interesting way to put it. I think of all the ways insurance companies prevent patients getting the best care. We have to complete enormous amounts of forms and justification for everything we do. Doesn’t anyone trust us anymore to do the correct thing?
Dr. Milton: Does any of that improve patient care? I don’t think so.
Dr. Sam: I agree. In fact it decreases quality of care. Many times I think the care that I plan exceeds the care recommended by insurance companies.
Dr. Yancy: Isn’t that the truth? The insurance companies, HMOs, Medicare, Medicaid all want us to work faster and be more efficient and they keep putting in road blocks so we can’t to do that efficiently.
Dr. Rosen: They think by eliminating tests and procedures they lower the cost of care. They can’t connect to the next level where morbidity increases and life takes a sharp turn to the left.
Dr. Sam: Of course a dead patient consumes considerable less health care costs.
Dr. Rosen: But you best not mention that fact our loud.
The Staff Lounge Is Where Unfiltered Opinions Are Heard.
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8. Voices of Medicine: A Review of Local and Regional Medical Journals and Articles
The magazine of the Sonoma County Medical Association
Allan Bernstein, MD
Pain is an essential part of our survival mechanism. It warns us that we stepped on a nail or that the coffee is too hot. It triggers autonomic responses that adjust our blood pressure, heart rate, pupillary reactions, blood sugar and blood cortisol levels. It is a warning to get our hand away from the flame and that our shoe is too tight. Pain is something we learn from. We’d like to avoid it, but we need it.
Pain typically indicates injury or potential injury, starting with tissue damage, releasing cytokines, stimulating peripheral nerves, and progressing proximally through nerve roots, spinal cord and into the brain. Spinal reflexes to pain allow us to pull our hand away from a painful stimulus before it even registers in our brain. A series of on/off switches along the way, particularly in the spinal cord and brainstem, allow us to modulate the pain and interpret the meaning. The endpoint, after multiple connections, is the frontal cortex, where we can localize the pain and decide how significant it is. Read more . . .
There are learned behaviors in our reaction to pain and genetic differences as to how we rate pain. “Big boys don’t cry” and “crybaby” are terms used in some cultures but not others. When I was studying painful neuropathy, using a 100-point pain scale, some subjects rated their pain at 80 while others claimed 20 for what appeared (to me) to be similar pain. After treatment, the 80s went to 70 and the 20s went to 17, a statistically identical percentage of reduction. Did one group feel more pain, or were they culturally sensitive when describing pain?
Anticipating pain will activate pain receptors and the appropriate autonomic responses. In contrast, anticipating pain relief will reduce pain signals, at least transiently. Nocebo responses (expecting something bad to happen) and placebo responses (expecting and getting benefit no matter what the treatment) may confound our research studies, but they can be turned into powerful clinical tools. The 45% placebo response in pain research tells us how much anticipation of relief affects our perception of pain.
The brain can create pain that isn’t there, such as phantom limb pain, and override significant pain when circumstances are appropriate, such as war injuries. Chronic pain--pain that persists in spite of no new tissue damage--represents a failure of the normal system that modulates pain.
Suffering is an individual’s emotional response to pain. It is not related to the intensity of the pain, but rather to fear, frustration and lack of understanding as to the meaning of the pain. If the etiology of the pain is well understood, one can rationalize severe pain as due to a specific injury, with an anticipated endpoint. Comprehension may not reduce pain, but it can moderate suffering for many people. The language we use to describe unpleasant situations often hints at a lack of control. We “suffer in silence,” “suffer the consequences” and “suffer the loss of a loved one.” These situations do not describe physiologic pain, but the emotional part of the pain--suffering--is the prominent feature that appears out of our control.
Both pain and suffering are difficult to measure. Pain fibers can be monitored in experimental animals. We assume pain is present when autonomic features appear in correspondence to the level of electrical impulses along pain pathways. We can measure endorphins and serotonin in spinal fluid. While both increase in response to acute pain, they both go down in chronic pain. As we gradually lose our ability to modulate pain, our suffering rises. Raising the level of endorphins and serotonin--through medications, spinal stimulators, exercise, cognitive therapy and diets--may improve pain control and relieve suffering. Therapies such as music, dance, painting and other pleasurable activities also reduce pain and suffering. Dopamine stimulation appears to be the physiologic pathway . . .
Read the entire article at Sonoma Medicine . . .
Dr. Bernstein, a Sebastopol neurologist, serves on the SCMA Editorial Board.
VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about
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9. Book Review: Gulp: Adventures on the Alimentary Canal by Mary Roach
CURRENT BOOKS: Chewing the Fat
By Jeff Sugarman, MD
Gulp, the new book by science writer/humorist Mary Roach, offers an entertaining if somewhat meandering and tangential tour of the alimentary canal. From top to bottom Roach takes us to places we never knew existed, and she digs down deeply into the often odd and esoteric research of those committed to exploring where no one has wanted to go before.
Roach reminds us that taste is all about smell, especially if you are a dog. As a dog owner, I found her expose of the Palatability Assessment Resource Center (PARC), a pet food tasting research center, fun and interesting. She opens a strange and charming window into the life of a professional pet food taster. Who knew that if a pet food manufacturer wants to make a claim that dogs prefer brand X of kibble, the manufacturer must actually get data to support their claims at a lab like PARC?
Roach’s exploration of the science of saliva is quite entertaining as well. I was startled at the strangeness of some of the scientific projects she describes. For example, how does salivary breakdown of starch enhance flavor? Subjects in one study had to rate the taste of custard samples. Sounds like a great study to volunteer for, right? What the subjects did not know was that a drop of saliva was secretly added to their meal. Roach does not go into detail as to how the saliva samples were actually obtained. Read more . . .
The indefatigable Roach amasses so many fun facts that weaving them together into any kind of coherent story at times proves too difficult. The transitions from fact to factoid are often forced and create a zigzagging story line that dilutes from the theme she is attempting to illustrate. Her extensive footnoting, which in places seems to take up nearly as much text as the main body of the book, allows her to weave even more tangents into her story. They are often more entertaining than the stories in the main text.
The historical vignettes that provide the backdrop to our knowledge of certain digestive processes are quite compelling. In pursuing the digestive properties of the stomach, Roach explores the relationship between Alexis St. Martin, a trapper who was accidentally shot, leaving him with a fistula between his stomach and his skin, and William Beaumont, a researcher who experimented on St. Martin for several decades. The reader may forgive Roach for describing their relationship as “acid” because the interplay between these two and the resulting digestion experiments are so entertaining.
Starting with Moby Dick, Roach spends many pages on the historical pseudoscientific studies regarding the survivability of being eaten alive. “Would a man in a whale forestomach be crushed or merely tumbled?” she asks. The whole discussion seems ridiculous, but she does include some interesting research, including the work of 18th-century French naturalist Rene Reaumur, who studied raptor gizzard pressures using a small tube carrying meat.
My 15-year-old son would probably enjoy the sections describing the curiosities of the rectum. Here, Roach footnotes the work on gastrointestinal gas by Drs. Terdiman and Fardy. Similarly, the section on flatulence research would provide Daniel Tosh plenty of fuel for his stand-up jokes on “Tosh.0.” Of course Roach also can’t resist the stories of objects found by emergency department physicians that are stuck or lost in the anus.
Roach is also strangely attracted to macabre events, which she describes and embellishes with pithy details. In her section on the compliance of the stomach, she describes a woman whose stomach ruptured from overeating and the man who ate 18 pounds of cow brains. There is much to be learned here, although most of it may be utterly useless.
On the back cover, the book carries the label “science,” which is true in the loosest sense only. Gulp is not a serious book, notwithstanding the extensive referencing. However, how interesting could the alimentary canal really be to the lay reader? Roach cleverly solves this problem with humor, effectively holding our interest in areas that are often off limits. She approaches the very end of the alimentary canal, for example, by relaying interviews with prison inmates about the details of smuggling cell phones in their rectums. I can imagine Roach laughing to herself as she wrote this, and for that matter every page in this book, from the origins of fire-breathing dragons to the Bristol stool chart (complete with diagram).
Dr. Sugarman, a Santa Rosa dermatologist, serves on the SCMA Editorial Board.
The Book Review Section Is an Insider’s View of What Doctors are Reading about.
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10. Hippocrates & His Kin: Hippocrates would not have survived today. But will his kin?
Blood Tests, Anyone?
With the recent survey of variations in charges for a Lipid Panel to measure your cholesterol, triglycerides, LDL, HDLs, etc. from $10 to $10,169, calls for more regulations of the laboratory industry are everywhere. But these prices are the result of regulations. If we got the government, Medicare, Medicaid, and other middle men out of health care, just think what would happen. No patient in his right mind would pay those prices. In fact, sometimes some of my patients don’t think knowing their cholesterol is even worth $10. All those hospitals and labs that are charging more than $100 would go out of business within 30 days. What a neat way to trim health care costs. Permanently! Maybe that would also trim health insurance to only costly items. Remember the days when Blue Cross only covered expensive items like hospital admissions. Then Blue Shield was invented to cover surgery. Then we lost sight of what insurance was for. Now patients are asking for prescriptions to cover aspirin and vitamins.
What a back door approach to cover chump change!
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Has Medicare Made a Difference?
In 1964, a year before Medicare passed, seniors were paying 20% of their income on health care.31
In 2000, a study by the American Association of Retired Persons (AARP) found seniors paying about $2,510 per year - 19% of their income - on out-of-pocket costs.30 This does not include home care or nursing home care.
Since our personal HealthCare costs are the same before and after Medicare, how do we extract ourselves from the high cost of Medicare?
Hippocrates and His Kin / Hippocrates Modern
The Challenges of Yesteryear, Yesterday, Today & Tomorrow
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• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports.
• Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog.
• The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government.
• To read the rest of this column, please go to www.medicaltuesday.net/org.asp.
• The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business.
• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels.
• Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.
• The Heartland Institute, www.heartland.org, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?.
• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Be sure to read the current lesson on Economic Education.
• The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse."
• The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter.
• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis.
• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section.
• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission was to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, and was used by some as a justification for the Obama plan, they have lost sight of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions.
• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today.
• CATO. The Cato Institute (www.cato.org) was founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio, articles and books at www.cato.org/people/cannon.html.
• The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.
• The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]
• The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, wartime allows the federal government to grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St. Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in wartime, we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com.
• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read ? Choose recent issues. The last ten years of Imprimis are archived.
• John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information
• Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .
• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com/ To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .
• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
• FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser’s view on today’s health care problem: In today’s proposals for sweeping changes in the field of medicine, the term “socialized medicine” is never used. Instead we hear demands for “universal,” “mandatory,” “singlepayer,” and/or “comprehensive” systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this “nationalized financing” or “nationalized health insurance.” In a more honest day, it was called socialized medicine.
• Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."
• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.
• Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, which would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.
• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD. To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.
• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.
The AAPS California
Chapter is an unincorporated
association made up of members. The Goal of the AAPS California Chapter is to
carry on the activities of the Association of American Physicians and Surgeons
(AAPS) on a statewide basis. This is accomplished by having meetings and
providing communications that support the medical professional needs and
interests of independent physicians in private practice. To join the AAPS
California Chapter, all you need to do is join national AAPS and be a physician
licensed to practice in the State of California. There is no additional cost or
fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .
Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"
• PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.
Our motto, "omnia pro aegroto" means "all for the patient."
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Words of Wisdom
Life is very short and very uncertain; let us spend it as well as we can. –Samuel Johnson
God has promised forgiveness to your repentance; but he has not promised tomorrow to you procrastination. –St Augustine
Only he who does nothing makes a mistake. –French proverb
When I want to read a good book, I write one. –Benjamin Disraeli
We do not write in order to be understood, we write in order to understand. –C. Day-Lewis
All my major works have been written in prison. . . I would recommend prison not only to aspiring writers but to aspiring politicians, too. –Jawaharlal Nehru
Some Recent Postings:
In The April Issue:
Felix Dennis, a hedonist and media magnate, died on June 22nd aged 67
The Economist | From the print edition | Jul 5th 2014
SOMEWHERE in the hearts of all self-made wealthy people, said Felix Dennis, is a “sliver of razored ice”. He liked being rich, and liked advising people about how to achieve that enviable state. But making money, and then yet more of it, was to assuage inner demons, not to achieve happiness. Indeed what made him happy (and that only occasionally, he stressed) were modest pleasures: “Walking in the woods alone, or deeply ensconced in composing a difficult piece of verse, or sitting quietly with old friends over a bottle of wine, or feeding a stray cat.”
Fun and success, however, were another matter. To say he lived high on the hog would be an understatement. By his own estimate he spent $100m on drugs, drink, women and high living in just one decade. He had 14 mistresses on his personal payroll (“If it floats, flies or fu***,” he once said, it was better to rent than to buy.)
He could afford either. His publishing empire, by his death worth hundreds of millions of pounds, started when he turned up at the office of a backstreet rag called “Oz”. He was penniless, having sold his drum kit to pay for a girlfriend’s abortion. Minds met, and he became co-editor—only to end up in jail, briefly, on an obscenity charge when the “schoolkids” issue featured Rupert Bear, a children’s comic-strip character, deflowering “Gipsy Granny”. The judge sniped that the scruffy youngster was “very much less intelligent” than his two co-defendants. . . Read more . . .
If so, it did not hold him back. His publishing genius lay in spotting gaps in the market and launching titles to fill them. When he saw youngsters queuing in the street in Soho at 9am to watch Bruce Lee films, he launched “Kung-Fu Monthly”, flying to Hong Kong to interview the maestro, who conveniently then died, mysteriously: the media blackout which followed made his material sizzlingly interesting.
When the titles flourished, he licensed them in other countries, or sold them and started new ones. His later successes included the laddish “Maxim” and “The Week”, a lively digest of other outlets’ content. Its huge success in America confounded cynics who thought that the magazine market there was moribund.
He was no great editor and had mostly no interest in the subjects of his titles. Though he made a fortune from computer magazines, he abhorred gadgets. He found management boring too, revering cashflow, but boasting that he could not read a balance-sheet. Why bother, when you could hire people who could?
The secret of getting rich, he reckoned, lay in using other people’s talents—finding them, nurturing them, rewarding them, and when necessary dispensing with them. On top of that you needed persistence, practicality, stinginess, innovation, ruthlessness and fearlessness. The greatest hurdle to fortune was the desire for safety—as addictive as his beloved crack cocaine, but much worse for you, he said.
Biology caught up with him. He nearly died from Legionnaires’ disease, which, he wrote, is “especially lethal to coked-up, overweight, cigarette-smoking, malt-whisky-swilling idiots with too much money who believe they are built of titanium”. Having survived a nurse pouring icy water on his genitals to keep him from falling into a coma, he eventually resolved to ditch the drugs and took up a five-hour-a-day poetry habit instead.
Rhyme and reason
That seemed like a rich man’s folly at first. He paid his publisher to produce the first volume and toured the country by helicopter to give public readings. The promise of free (and rather good) wine brought punters flocking, and they liked what they heard. The books flew off the shelves just as fast as the magazines did. He was perhaps not Britain’s greatest living poet, but he was certainly one of the most popular. At their best, his verse—ironic, self-deprecatory, bleak and amusing by turns, had echoes of Kipling:
They tell me I’m riddled with cancer
So I’m planning to croak with élan
If you’ll pass the cigars and decanter
I’ll be dying as hard as I can.
He had other projects too, notably starting a 20,000 hectare hardwood forest (immodestly named the Forest of Dennis) on his estate, at a cost of £200m ($340m). By his death, more than 1m trees were planted. . .
His hippy streak could be deceptive. . . He liked intimacy on his terms, but nobody else’s. He had never “properly surrendered to love”; for all his audacity in other parts of life, it would require, he admitted, a particular kind of courage which he lacked.
On This Month in History - May
On the first day of this month in 1707, Great Britain was formed.
On the first day of this month in 1884, construction on the first skyscraper began.
On the first day of this month in 1931, the Empire State Building was dedicated.
On the second day of this month in 1952, the first jet airplane passenger service was launched.
On the third day of this month in 1765, the first medical school to offer a full-fledged diploma program was founded at what is now called the University of Pennsylvania.
On the third day of this month in1979, Margaret Thatcher became England’s first female Prime Minister.
After Leonard and Thelma Spinrad
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Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, any single payer initiative, Social Security was born for the benefit of the state and of a contemptuous disregard for people’s welfare.
We must also remember that ObamaCare has nothing to do with appropriate healthcare; it was similarly projected to gain loyalty by making American citizens dependent on the government and eliminating their choice and chance in improving their welfare or quality of healthcare. Socialists know that once people are enslaved, freedom seems too risky to pursue.