1. Featured
Article: Broken Promises By Allison Bond, Scientific American, April 2010
Brain scans reveal when a vow will not be honored
What goes on in the
brain of the groom who says "I do," then has an affair? Or the friend
who pledges to repay a loan but never does? Breaking a promise is a complex
neurobiological event, a new study shows—and a brain scan may be able to
predict those who are making false promises before they break their word.
Using functional MRI,
scientists at the University of Zurich in Switzerland scanned the brains of
subjects playing an investment game. Subjects assigned to be
"investors" had to decide whether to pledge to share their money with
other players who were "trustees." This arrangement boosted the
amount of money in the pot, but it also could result in a loss to the investor
if the trustee chose not to share. Nearly all the subjects said they would give
to the trustee—but in the end, not everyone kept this promise.
Based on the fMRI scans,
the researchers were able to predict whether the players would break their
promise before they actually had the chance to do so in the game. Promise
breakers had more activity in certain brain regions, including the prefrontal
cortex, an indication that planning and self-control were involved in
suppressing an honest response, and the amygdala, perhaps a sign of conflicting
and aversive emotions such as guilt and fear.
If the predictive
ability of these scans is borne out in future studies, someday the technique
could be of use to the justice system. "Brain imaging might be able to
help psychologists or psychiatrists decide whether a criminal offender can be
released or whether the risk of relapse is too high," says lead author
Thomas Baumgartner, who emphasizes that such scans would supplement assessments
by health professionals, not replace them.
Further Reading
Sounds Make Memories Stick
During Sleep
Can the Peace Drug Help
Clean Up the War Mess?
Feedback
. . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
*
* * * *
2. In the News: The Rise of Instant Wireless
Networks; Scientific American Magazine, April 2010; by Michelle Effros; Andrea Goldsmith; Muriel Médard;
Key
Concepts
• Ad-hoc wireless networks require no fixed infrastructure. Instead they pass information from device to device, forming a web of connections.
•
These networks can be used in places where building
traditional mobile network infrastructure would prove too unwieldy or
expensive—for example, in remote areas and combat zones.
•
Because any ad-hoc network is constantly in flux,
innovative strategies must be employed to avoid data loss and mitigate
interference.
In this era of Facebook, Twitter and the iPhone, it is
easy to take for granted our ability to connect to the world. Yet communication
is most critical precisely at those times when the communications
infrastructure is lost. In Haiti, for example, satellite phones provided by aid
agencies were the primary method of communication for days following the tragic
earthquake earlier this year. But even ordinary events such as a power outage
could cripple the cell phone infrastructure, turning our primary emergency
contact devices into glowing paperweights.
In situations such as these, an increasingly
attractive option is to create an "ad-hoc" network. Such networks
form on their own wherever specially programmed mobile phones or other
communications devices are in range of one another. Each device in the network
acts as both transmitter and receiver and, crucially, as a relay point for all
the other devices nearby. Devices that are out of range can communicate if
those between them are willing to help—passing messages from one to the next
like water in a bucket brigade. In other words, each node in the network
functions as both a communicator for its own messages and infrastructure for
the messages of others.
Disaster relief is but
one potential application for ad-hoc networks. They can serve anywhere building
a fixed infrastructure would be too slow, difficult or expensive. The military
has invested a large amount of money in designing these systems for
battlefield communications. Ad-hoc networks in your home would allow devices
to find one another and begin communication
automatically, freeing you from the tangle of wires in your living room and
office. Remote villages and lower-income neighborhoods that lack a broadband
infrastructure could connect via ad-hoc networks to the Internet. Scientists
interested in studying microenvironments in the treetops or hydrothermal vents
on the ocean floor could scatter sensors in their intended environment without
worrying about which sensors will hear one another or how information will
travel from the jungle to the researchers' laptops.
These networks have been in development for more than three
decades, but only in the past few years have advances in network theory given
rise to the first large-scale practical examples. In San Francisco, the
start-up Meraki Networks connects 400,000 San Francisco residents to the
Internet through their Free the Net project, which relies on ad-hoc networking
technology. Bluetooth components in cell phones, computer gaming systems and
laptops use ad-hoc networking techniques to enable devices to communicate
without wiring or explicit configuration. And ad-hoc networks have been
deployed in a variety of remote or inhospitable environments to gather
scientific data from low-power wireless sensors. A number of breakthroughs
must still be achieved before these networks can become commonplace, but
progress is being made on several fronts. . .
To
read the entire article . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
*
* * * *
3.
International
Medicine: Tories would force
hospitals to supply unprecedented levels of care data Denis Campbell , guardian.co.uk, April 2010
A
Conservative government would end the NHS's 'secretive' attitude so patients
can decide where to go for treatment, says shadow health secretary Andrew
Lansley
Hospitals will be forced to give NHS patients unprecedented details
about whether they provide good or bad healthcare so people can decide where to
go for treatment, the Conservatives have
pledged.
The move would end the NHS's "secretive" and "highly
paternalistic" attitude to giving patients information and drive up the
quality of care by using data to expose hospitals that provide inadequate
service, shadow health secretary Andrew Lansley told SocietyGuardian.
He detailed how a Conservative government would ensure that patients were
routinely told:
• How successful different types of surgery at a particular hospital had
been, judged by how soon patients were able to return to work, whether or not
they were left pain-free and how many had to undergo further treatment
• Ward-by-ward infection rates for all superbugs, not just MRSA and Cdifficile
• How many new mothers were left alone in labour and found it scary
• How many of the hospital's staff would be happy to be treated there
• Its rate of patient readmission - a key indicator of quality of care
• How much single-sex accommodation it had and numbers of single rooms
• How many patients died during or soon after treatment
• The number of complaints it had been receiving.
Lansley also promised that he would institute regular surveys of large
numbers of patients which ask searching questions about how they felt about
their experience in hospital, for instance if they were happy with the staff's
response when they pressed their call button.
The NHS is "a vast information-gathering machine" but is poor at
giving patients useful information in a clear, accessible way, said Lansley.
"Clearly [the NHS] is too secretive ... and it's a secrecy that is both
unnecessary and unhealthy. There's a culture inside the NHS which is highly
paternalistic. You know, 'We give them the service and they are grateful,' and
we have to move to shared decision-making. Our interaction as patients with the
NHS should be on the basis that there's a presumption that all information is
shared with us," he added.
But the British Medical Association, the doctors' trade union, raised
concerns about Lansley's plan. "We welcome patients having more
information, which is good and relevant information, because that's what
doctors do," said Keith Brent, deputy chair of the BMA's consultants
committee. "But crude, uninterpreted data could frighten people
unnecessarily and demoralise staff. I would have particular concerns about
simply publishing crudely the outcomes of surgery, because those very much
depend on how the patient was before they went into surgery. The quality of
hospital care isn't the only factor. If crude figures could then come out with
some very bizarre results [and] would frighten patients away from units that
actually provide very good care."
Brent also warned that surgical units could respond by refusing to operate
on sicker patients whose outcomes might then make its performance look bad. . .
"Like all hospitals we collect a great deal of data and we believe
it's important to share the information with patients in a useful form. It's
important to ask patients for their input as well, so we have developed our own
patient questionnaires which go beyond the questions asked in the national NHS
inpatient survey," said Karen Castille, chief nurse and operating officer
at Cambridge University hospitals NHS foundation trust. . . .
Hospital leaders welcomed Lansley's plans. "The general principle of
sharing much more information with patients is absolutely right," said
Nigel Edwards, policy director of the NHS Confederation. "The evidence
internationally is that this information isn't greatly used by patients but has
a profound effect and the providers, who take big notice of it and use it to
target improvements."
Making much more information readily and quickly available would also flag
up problems very soon after they emerge, and prevent hospitals covering up the
way that, for example, Stafford hospital disguised weaknesses that official
inquiries have since found contributed to the deaths of hundreds of patients.
"Things like a ward where people are getting pressure sores, or may be
suffering from deep vein thrombosis, there should be no hiding place for
that," said Lansley.
The Royal College of Surgeons of England said it backed all information
being available to patients, as long as it was adjusted for risk. Surgeons were
already developing public audits that record the outcomes of treatment, and
such audits had already improved standards in heart surgery, a spokesman said.
Read the entire article . . .
Feedback
. . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
The NHS does
not give timely access to quality healthcare.
*
* * * *
4. Medicare: ObamaCare: Repeal, Replace or What? WSJ, March 26, 2010
Editor's Note: We
asked five opponents of government-directed health care for their thoughts on
our new health-care entitlement. Specifically: Now that ObamaCare is law, how
should Republicans respond? Should they work to repeal some or all of it, and
do they need to offer an alternative health reform proposal of their own?
Massachusetts
Is Our Future, By
Timothy P. Cahill
White House Senior Adviser David Axelrod hailed the
Massachusetts health-care program as "the template" for the national
health-care reform legislation the president signed into law earlier this week.
That should be cause for serious concern about this law's ability to improve
our health-care system at an affordable cost.
As state treasurer, I
can speak with authority about the Massachusetts pilot program. It has been a
fiscal train wreck.
The universal
insurance coverage we adopted in 2006 was projected to cost taxpayers $88
million a year. However, since this program was adopted in 2006, our
health-care costs have in total exceeded $4 billion. The cost of Massachusetts'
plan has blown a hole in the Commonwealth's budget. Just last Thursday, Gov.
Deval Patrick's office announced a $294 million shortfall related to
health-care costs. . .
Mr. Cahill is the state treasurer of
Massachusetts. He is currently running as an independent for governor.
We Good Europeans,
By Mitch Daniels
As if governors these days don't have enough on their
plates. Now that ObamaCare has become law, there's a whole new to-do list for
my state:
1) Plan for the termination of our Healthy Indiana Plan. This is the
program that's currently providing health insurance to 50,000 low-income
Hoosiers. With its health savings account-style personal accounts, it has been
enormously popular among its participants. I hope those folks will do all right
when they are pitched into Medicaid.
2) Start
preparing voters for a state tax increase. The axe won't fall until someone
else is governor. But when we are forced to expand Medicaid to one in every
four citizens, the cost will add several hundred million dollars to the budget.
3) Check to
see if Indiana should drop its health insurance plans and dump its government
workers into the exchanges. . . .
4) Ramp up
our job retraining programs to handle those who will be fired by our medical
device companies, student loan providers, and small businesses as they wrestle
with new taxes, penalties, or in the student loan case, outright
nationalization of their business.
5) Call the
state's attorney general to see if we can join one of the lawsuits to overturn
ObamaCare. Yes, it's a long shot. But why not try?
6) Investigate
an offset to all this extra cost. We may no longer need the Department of
Insurance since insurers will now be operating as regulated utilities under the
thumb of the federal government.
It's discouraging
that all of this could have been avoided. Congress could have done what
Republicans should suggest now: Shift to a system that allows individuals—not
businesses—to buy health insurance tax free. They could also create tax credits
for buying health insurance based on income and health status to guarantee
everyone coverage and encourage medical care and insurance competition.
Republicans should push to lower barriers for buying insurance across state
lines, create incentives for states to repeal mandates, and limit frivolous
lawsuits that increase the price of insurance.
But for the moment,
our federal overlords have ruled. We better start adjusting to our new status
as good Europeans.
Mr. Daniels, a Republican, is governor of Indiana.
Resistance Is Not Futile
By Phil Gramm
For every dollar's
worth of health care that Americans received last year, they paid a dime and
somebody else paid 90 cents. If you bought food the way you buy health
care—where 90% of everything you put in your basket was paid for by your
grocery insurance policy—you would eat differently and so would your dog. We
have the best health-care system in the world, but as rich as America is we
can't afford it. . . .
Even though the Obama bill became far more unpopular than
the Clinton bill ever was, the daunting size and rigid commitment of the
Democratic majority to a government-run system was such that they could
override public opinion. Now the Democrats are out to make Americans like their
plan—or at least get them to acquiesce to it. But as Gandhi once explained,
40,000 British troops cannot force 300 million Indians to do what they will not
do.
Republicans have a
job to do. They must make it clear to the American people that this is only the
beginning of the debate. There will be two congressional elections and a
presidential election before the government takeover is implemented in 2014. .
.
If Republicans don't want America to follow Britain and
Canada down the road to socialized medicine, they must change the system so
that families have more power to control their own health-care costs. This will
entail real changes like tax deductions for health insurance, not for prepaid
medicine; refundable tax credits for families to buy their own insurance;
freedom to negotiate with insurance companies; rewarding healthy lifestyles;
tort reform; and reforming Medicare and Medicaid so every consumer has
deductibles and copayments based on their income. This system will require
Americans to make choices in health care—just as they do in every other area of
their lives. . .
Mr. Gramm, a Republican, was a senator from
Texas from 1985 to 2002 and served as chairman of the Health subcommittee of
the Senate Committee on Finance.
Persistence Is the Key
By Bobby Jindal
After forcing through
a massive health-care overhaul that the public does not want, the president and
Democratic leaders in Congress are threatening us with yet another PR campaign
to make us like it. Good luck with that.
Meanwhile, some level
of handwringing has broken out among GOP strategists. Should we push for
repeal? Will it work? Is there some danger in that strategy?
Well, let's see. We
just spent 13 months arguing against the Democrats' top-down approach to health
care, contending that it must be stopped for the good of our country, the
health of our citizens, and the future of our nation's economy. So, should we
try to repeal it? Only in Washington is this a hard question.
The arguments against
repeal and the response is the following: Let's take them one at a time.
1) It's impossible. Wrong.
There is a first time for everything. It's similarly "impossible" for
the son of Indian immigrants to get elected in the deep South. It's impossible
for an African-American to get elected president. You get the picture.
2) President Obama would veto a repeal bill.
Yes, he sure would. Do it anyway. And do it again after he is gone. (By the
way, President Clinton vetoed welfare reform twice before he signed it into
law.)
3) It will be hard to take
things away. Probably so. But the reality is that growth of federal
entitlements is strangling the economic engine of our country. Someone has to
draw the line somewhere. Do we want to go the way of Western Europe? If not, we
better get moving in the other direction immediately.
4) There are parts of the bill
the public will like. No doubt about it. There are parts I like—though I
have yet to read the fine print—such as allowing parents to keep kids on their
policies until they are 26-years-old. And there's bound to be more good policy
in there: 2,409 pages can't be all bad. But the overall direction of the bill
is to empower government, not patients.
5) We don't want to be labeled the party of
"no." As it pertains to this bill, how about "hell no"? Newt Gingrich is saying we should
"repeal and replace." That works.
Mr. Jindal, a Republican, is the governor of
Louisiana.
Printed in The Wall Street Journal,
March 26, 2010, page A19
Read the entire OpEd . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
Government is not the solution to our
problems, government is the problem.
-
Ronald Reagan
* * * * *
5. Medical Gluttony: Electronic Medical Records: How long
does it take to read 243 pages?
To
try to make sense of the political climate of the EMR might be blasphemous. In
our pulmonary office we have what I consider digital records for about twenty
years. By the late 1980s, my associates and I had seen about 29,000 pulmonary
consultations. We had a numeric filing system in which the first number would
tell us whether the consult originated in the hospital, our office or was
referred in. After twenty years, the volume had become unmanageable unless an
extensive card catalog or computer was close at hand that would identify the
patient's number, which would lead us to the correct chart. When the chart had
served its current purpose it could be re-filed because of terminal digit
filing. We simplified the system by filing alphabetically. Although our
advisers said we only need the first two digits of the last name on the chart,
we decided to put the first three digits highlighted since we had twenty
Johnsons, 15 Browns, and 10 Rodriguez'. We also decided that all medical
histories and physical examinations, along with the pulmonary function tests,
arterial blood gases, electrocardiograms and chest x-rays we took in our office
would be typed up and filed electronically.
This
is not the EMR that the late Senator Kennedy, President Bush, or the current
White House resident desired, but it served our purpose. Easy access and
retrievability, short five- to eight-page complete medical record, easy to
review quickly, to duplicate to a consulting physician, and easy to update
yearly. Since the California Medical Board only allows refills for a maximum of
one year without an examination, and since most of our pulmonary patients,
whether emphysema, asthma, bronchitis, silicosis, asbestosis, sarcoidosis,
inactive tuberculosis, histoplasmosis, and others should be evaluated in some
detail at least yearly, we saw all patients for an annual exam, even though
they may have had office visits during the course of the year. This also
allowed us to have a continuing digital record simply by copying and pasting
the previous year's record and revising it with the patient in front of us. We
would then end up with another current five- to eight-page record plus the
current CXR, PFT, ABG, ECG, which would then be placed on top of the patient's
file. All the previous pages would be kept in the paper file, but the yearly
exams would always be on the computer. This has been important in a number of
instances when a patient moves out of town or goes to another medical facility
for 10 or 15 years and then returns. The cost of storage of our records reached
$22,000 for the first twenty, at which time we began shredding records after
four years of inactivity. We could always print out the previous annual exams to
start a new record a decade or two later.
Recently,
we have received EMRs from patients that have been elsewhere. These records in
several instances reach 195 pages and in one case 243 pages. These are the type
of records that Congress and the President desire everyone should have to
improve healthcare and reduce costs by making medical care more efficient.
However, we have found that it is much more time consuming to wade through
several hundred pages of electronic records with endless duplications, variations
from one physician to the next, outright differences in the exam of the same
patient, and duplication of errors as one doctor copies the previous record of
another physician into his own records, even though there are blatant errors.
It has also become apparent that one physician has not reexamined much of what
is recorded as being done by him. Also, these are written records and our
compact eight to 12 pages a year is completely overwhelmed by these outside
EMRs of hundreds of pages. In fact, at times it is difficult to find our
succinct but complete records in the midst of all this paper.
If
electronic medical records could be transferred electronically, would this have
been easier? In our experience, we are now getting CDs of EMRs that can be loaded
into our computer. We have the capability to download these hundreds of pages
right into our digital records. Administrators are very proud to facilitate
this. They tell us this should make it much easier to review the 195 or the 243
pages of digital records.
However,
we have not found this to be the case. Each of us found that we could review
243 pages using our ten fingers to hold places and make much more out of the
review than in running pages on our computer screen that fast, which limits the
ability to absorb any details, take notes, and then retype a summation for our
consult that would make sense to the next consultant.
I
wonder what would happen if we started meddling with attorney's client records
like the bureaucratic attorneys are meddling in medical histories?
Has anyone
tried to tell attorneys how they should record their legal records?
Feedback
. . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
Medical Gluttony thrives in Government and Health
Insurance Programs.
It Disappears with Appropriate Deductibles and
Co-payments on Every Service.
*
* * * *
6. Medical
Myths: With all this oversight, ObamaCare can't help but be successful!
It's
not just a healthcare coverage law. It's alllllll that goes with it. Layers and
layers and layers and layers of government bureaucracy, employees paid out
of our taxes, including their benefits, retirement plans and on and on and
on......
With older physicians retiring rather than face all the bureaucracy, red tape
and reduced fees paid, and younger ones going underground or leaving the
profession altogether, we won't have enough doctors
New Boards and Commissions created in the NEW OBAMA
HEALTH CARE
Take a good look at the face of statism.
1. Grant program for consumer assistance offices
(Section 1002, p. 37)
2. Grant program for states to monitor premium increases (Section 1003, p. 42)
3. Committee to review administrative simplification standards (Section 1104,
p. 71)
4. Demonstration program for state wellness programs (Section 1201, p. 93)
5. Grant program to establish state Exchanges (Section 1311(a), p. 130)
6. State American Health Benefit Exchanges (Section 1311(b), p. 131)
7. Exchange grants to establish consumer navigator programs (Section 1311(i),
p. 150)
8. Grant program for state cooperatives (Section 1322, p. 169)
9. Advisory board for state cooperatives (Section 1322(b)(3), p. 173)
10. Private purchasing council for state cooperatives (Section 1322(d), p. 177)
11. State basic health plan programs (Section 1331, p. 201)
12. State-based reinsurance program (Section 1341, p. 226)
13. Program of risk corridors for individual and small group
markets (Section 1342, p. 233)
14. Program to determine eligibility for Exchange participation (Section 1411,
p. 267)
15. Program for advance determination of tax credit eligibility (Section 1412,
p. 288)
16. Grant program to implement health IT enrollment standards (Section 1561, p.
370)
17 Federal Coordinated Health Care Office for dual eligible beneficiaries
(Section 2602, p. 512)
18. Medicaid quality measurement program (Section 2701, p. 518)
19. Medicaid health home program for people with chronic conditions, and grants
for planning same (Section 2703, p. 524)
20 Medicaid demonstration project to evaluate bundled payments (Section
2704, p. 532)
21. Medicaid demonstration project for global payment system (Section
2705, p. 536)
22. Medicaid demonstration project for accountable care organizations (Section
2706, p. 538)
23. Medicaid demonstration project for emergency psychiatric care (Section
2707, p. 540)
24. Grant program for delivery of services to individuals with postpartum
depression (Section 2952(b), p. 591)
25. State allotments for grants to promote personal
responsibility education programs (Section 2953, p. 596)
26. Medicare value-based purchasing program (Section 3001(a), p. 613)
27. Medicare value-based purchasing demonstration program for critical
access hospitals (Section 3001(b), p. 637)
28. Medicare value-based purchasing program for skilled nursing
facilities (Section 3006(a), p. 666)
29. Medicare value-based purchasing program for home health
agencies (Section 3006(b), p. 668)
30. Interagency Working Group on Health Care Quality (Section 3012, p.
688)
31. Grant program to develop health care quality measures (Section 3013,
p. 693)
32. Center for Medicare and Medicaid Innovation (Section 3021, p.
712)
33. Medicare shared savings program (Section 3022, p. 728)
34. Medicare pilot program on payment bundling (Section 3023, p. 739)
35. Independence at home medical practice demonstration program
(Section 3024, p. 752)
36. Program for use of patient safety organizations to reduce hospital
readmission rates (Section 3025(b), p. 775)
37. Community-based care transitions program (Section 3026, p. 776)
38. Demonstration project for payment of complex diagnostic laboratory
tests (Section 3113, p. 800)
39. Medicare hospice concurrent care demonstration project (Section 3140,
p. 850)
40. Independent Payment Advisory Board (Section 3403, p. 982)
41. Consumer Advisory Council for Independent Payment Advisory Board (Section
3403, p. 1027)
42. Grant program for technical assistance to providers implementing
health quality practices (Section 3501, p. 1043)
43. Grant program to establish interdisciplinary health teams (Section
3502, p. 1048)
44. Grant program to implement medication therapy management (Section
3503, p. 1055)
45. Grant program to support emergency care pilot programs (Section 3504,
p. 1061)
46. Grant program to promote universal access to trauma services (Section
3505(b), p. 1081)
47. Grant program to develop and promote shared decision-making aids (Section
3506, p. 1088)
48. Grant program to support implementation of shared decision-making (Section
3506, p. 1091)
49. Grant program to integrate quality improvement in clinical education
(Section 3508, p. 1095)
50. Health and Human Services Coordinating Committee on Women's Health (Section
3509(a), p. 1098)
51. Centers for Disease Control Office of Women's Health (Section 3509(b), p.
1102)
52. Agency for Healthcare Research and Quality Office of Women's Health
(Section 3509(e), p. 1105)
53. Health Resources and Services Administration Office of Women's Health
(Section 3509(f), p. 1106)
54. Food and Drug Administration Office of Women's Health (Section 3509(g), p.
1109)
55. National Prevention, Health Promotion, and Public Health Council (Section
4001, p. 1114)
56. Advisory Group on Prevention, Health Promotion, and Integrative and Public
Health (Section 4001(f), p. 1117)
57. Prevention and Public Health Fund (Section 4002, p. 1121)
58. Community Preventive Services Task Force (Section 4003(b), p. 1126)
59. Grant program to support school-based health centers (Section 4101,
p. 1135)
60. Grant program to promote research-based dental caries disease
management (Section 4102, p. 1147)
61. Grant program for States to prevent chronic disease in Medicaid
beneficiaries (Section 4108, p. 1174)
62 Community transformation grants (Section 4201, p. 1182)
63. Grant program to provide public health interventions (Section 4202, p
1188)
64. Demonstration program of grants to improve child immunization rates
(Section 4204(b), p. 1200)
65. Pilot program for risk-factor assessments provided through community
health centers (Section 4206, p. 1215)
66. Grant program to increase epidemiology and laboratory capacity (Section
4304, p. 1233)
67. Interagency Pain Research Coordinating Committee (Section 4305, p. 1238)
68. National Health Care Workforce Commission (Section 5101, p. 1256)
69. Grant program to plan health care workforce development activities (Section
5102(c), p. 1275)
70. Grant program to implement health care workforce development
activities (Section 5102(d), p. 1279)
71. Pediatric specialty loan repayment program (Section 5203, p. 1295)
72. Public Health Workforce Loan Repayment Program (Section 5204, p. 1300)
73. Allied Health Loan Forgiveness Program (Section 5205, p. 1305)
74. Grant program to provide mid-career training for health professionals
(Section 5206, p. 1307)
75. Grant program to fund nurse-managed health clinics (Section 5208, p. 1310)
76 Grant program to support primary care training programs (Section 5301,
p. 1315)
77. Grant program to fund training for direct care workers (Section 5302,
p. 1322)
78. Grant program to develop dental training programs (Section 5303, p. 1325)
79. Demonstration program to increase access to dental health care in
underserved communities (Section 5304, p. 1331)
80. Grant program to promote geriatric education centers (Section 5305,
p. 1334)
81. Grant program to promote health professionals entering geriatrics
(Section 5305, p. 1339)
82. Grant program to promote training in mental and behavioral health (Section
5306, p. 1344)
83. Grant program to promote nurse retention programs (Section 5309, p.
1354)
84. Student loan forgiveness for nursing school faculty (Section 5311(b),
p. 1360)
85. Grant program to promote positive health behaviors and outcomes (Section
5313, p. 1364)
86. Public Health Sciences Track for medical students (Section 5315, p.
1372)
87. Primary Care Extension Program to educate providers (Section 5405, p.
1404)
88. Grant program for demonstration projects to address health workforce
shortage needs (Section 5507, p. 1442)
89. Grant program for demonstration projects to develop training programs
for home health aides (Section 5507, p. 1447)
90 Grant program to establish new primary care residency programs (Section
5508(a), p. 1458)
91. Program of payments to teaching health centers that sponsor medical
residency training (Section 5508(c), p. 1462)
92. Graduate nurse education demonstration program (Section 5509, p. 1472)
93. Grant program to establish demonstration projects for community- based
mental health settings (Section 5604, p. 1486)
94. Commission on Key National Indicators (Section 5605, p. 1489)
95. Quality assurance and performance improvement program for skilled
nursing facilities (Section 6102, p. 1554)
96. Special focus facility program for skilled nursing facilities (Section
6103(a)(3), p. 1561)
97. Special focus facility program for nursing facilities (Section
6103(b)(3), p. 1568)
98. National independent monitor pilot program for skilled nursing facilities
and nursing facilities (Section 6112, p. 1589)
99. Demonstration projects for nursing facilities involved in the culture
change movement (Section 6114, p. 1597)
100. Patient-Centered Outcomes Research Institute (Section 6301, p. 1619)
101. Standing methodology committee for Patient-Centered Outcomes Research
Institute (Section 6301, p. 1629)
102. Board of Governors for Patient-Centered Outcomes Research Institute
(Section 6301, p. 1638)
103. Patient-Centered Outcomes Research Trust Fund (Section 6301(e), p.
1656)
104. Elder Justice Coordinating Council (Section 6703, p. 1773)
105. Advisory Board on Elder Abuse, Neglect, and Exploitation (Section 6703, p.
1776)
106. Grant program to create elder abuse forensic centers (Section 6703,
p. 1783)
107. Grant program to promote continuing education for long-term care staffers
(Section 6703, p. 1787)
108. Grant program to improve management practices and training (Section 6703,
p. 1788)
109. Grant program to subsidize costs of electronic health records (Section
6703, p. 1791)
110. Grant program to promote adult protective services (Section 6703, p.
1796)
111. Grant program to conduct elder abuse detection and prevention (Section
6703, p. 1798)
112. Grant program to support long-term care ombudsmen (Section 6703, p. 1800)
113. National Training Institute for long-term care surveyors (Section 6703, p.
1806)
114 Grant program to fund State surveys of long-term care residences (Section
6703, p. 1809)
115. CLASS Independence Fund (Section 8002, p. 1926)
116. CLASS Independence Fund Board of Trustees (Section 8002, p.
1927)
117. CLASS Independence Advisory Council (Section 8002, p. 1931)
118. Personal Care Attendants Workforce Advisory Panel (Section 8002(c),
p. 1938)
119 Multi-state health plans offered by Office of Personnel Management
(Section 10104(p), p. 2086)
120. Advisory board for multi-state health plans (Section 10104(p), p. 2094)
121. Pregnancy Assistance Fund (Section 10212, p. 2164)
122. Value-based purchasing program for ambulatory surgical centers (Section
10301, p. 2176)
123. Demonstration project for payment adjustments to home health services
(Section 10315, p. 2200)
124. Pilot program for care of individuals in environmental emergency
declaration areas (Section 10323, p. 2223)
125. Grant program to screen at-risk individuals for environmental health
conditions (Section 10323(b), p. 2231)
126. Pilot programs to implement value-based purchasing (Section 10326, p.
2242)
127. Grant program to support community-based collaborative care networks
(Section 10333, p. 2265)
128. Centers for Disease Control Office of Minority Health (Section 10334, p.
2272)
129. Health Resources and Services Administration Office of Minority Health
(Section 10334, p. 2272)
130. Substance Abuse and Mental Health Services Administration Office of
Minority Health (Section 10334, p. 2272)
131. Agency for Healthcare Research and Quality Office of Minority Health
(Section 10334, p. 2272)
132. Food and Drug Administration Office of Minority Health (Section 10334, p.
2272)
133. Centers for Medicare and Medicaid Services Office of Minority Health
(Section 10334, p. 2272)
134. Grant program to promote small business wellness programs (Section 10408,
p 2285)
135. Cures Acceleration Network (Section 10409, p. 2289)
136. Cures Acceleration Network Review Board (Section 10409, p. 2291)
137. Grant program for Cures Acceleration Network (Section 10409, p. 2297)
138. Grant program to promote centers of excellence for depression (Section
10410, p. 2304)
139. Advisory committee for young women's breast health awareness education
campaign (Section 10413, p. 2322)
140. Grant program to provide assistance to provide information to young women
with breast cancer (Section 10413, p 2326)
141. Interagency Access to Health Care in Alaska Task Force (Section
10501, p. 2329)
142. Grant program to train nurse practitioners as primary care providers
(Section 10501(e), p. 2332)
143. Grant program for community-based diabetes prevention (Section 10501(g),
p. 2337)
144. Grant program for providers who treat a high percentage of medically
underserved populations (Section 10501(k), p. 2343)
145. Grant program to recruit students to practice in underserved communities
(Section 10501(l), p. 2344)
146. Community Health Center Fund (Section 10503, p. 2355)
147. Demonstration project to provide access to health care for the uninsured
at reduced fees (Section 10504, p. 2357)
148. Demonstration program to explore alternatives to tort litigation (Section
10607, p. 2369)
149. Indian Health demonstration program for chronic shortages of health
professionals (S. 1790, Section 112, p. 24)*
150. Office of Indian Men's Health (S. 1790, Section 136, p. 71)*
151. Indian Country modular component facilities demonstration program (S.
1790, Section 146, p. 108)*
152. Indian mobile health stations demonstration program (S. 1790, Section 147,
p. 111)*
153. Office of Direct Service Tribes (S. 1790, Section 172, p. 151)*
154. Indian Health Service mental health technician training program (S. 1790,
Section 181, p. 173)*
155. Indian Health Service program for treatment of child sexual abuse
victims (S. 1790, Section 181, p. 192)*
156. Indian Health Service program for treatment of domestic violence and
sexual abuse (S. 1790, Section 181, p. 194)*
157. Indian youth telemental health demonstration project (S. 1790, Section
181, p. 204)*
158. Indian youth life skills demonstration project (S. 1790, Section 181, p.
220)*
159. Indian Health Service Director of HIV/AIDS Prevention and Treatment (S
1790, Section 199B, p. 258)*
*Section
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
With all this oversight and bureaucracy, it should be catastrophic.
*
* * * *
7. Overheard in the Medical Staff Lounge: Has the Debate
Ended or Just Begun?
Dr. Sam:
Since we spoke last month, the Health Care Bill has passed.
Dr. Dave: Yes,
by political maneuvering which makes most of us ashamed of how low they
stooped.
Dr. Yancy: I
no longer accept Medicare. If I'm forced into ObamaCare, I will close my
practice.
Dr. Milton:
There is a Dermatologist in Phoenix who put up a sign in his waiting room. If
you voted for Obama, you should be aware that if ObamaCare is not repealed or
thrown out by the Supreme Court by 2014 when it would be fully implemented,
THIS OFFICE IS CLOSED.
Dr. Yancy: I
would second that.
Dr. Milton:
This Dermatologist said the worst part of ObamaCare was the increase in the
fine for medical errors that went from $5,000 to $50,000.
Dr. Sam:
That would close me down in a hurry. That's equivalent to three years of office
rent.
Dr. Paul: What makes you think that if the government
can force people to purchase insurance against their will, they couldn't force
you to practice medicine against your will?
Dr. Dave:
What a scary thought. That would be a more powerful government than a dictator.
I don't think Stalin, Hitler, Mao or Mussolini would be able to force their
subjects to purchase insurance.
Dr. Paul:
They just provided health care from the general coffers.
Dr. Dave:
And what quality of health care did they provide?
Dr. Paul:
But they provided coverage.
Dr. Dave: Coverage
is a meaningless term if you still can't get quality care.
Dr. Paul:
The next thing you'll say is that Castro didn't provide quality care.
Dr. Dave:
That's obvious. He barely provided any even decent care.
Dr. Paul:
Didn't Michael Moore say that even heart surgery was better in Cuba?
Dr. Dave:
When Michael Moore needs heart surgery and has it in Cuba, that will solve the
Michael Moore problem for good.
Dr. Yancy:
Boy, would I love to fix his hernia problem. It would never recur.
Dr. Paul: If
you fixed his hernia, gangrene would probably do him in.
Dr. Yancy: As
I said, it would never recur.
Dr. Rosen:
Hey, fellows, let's get back on track. We were just getting to coverage and how
that didn't mean getting access to care.
Dr. Paul:
But that's all the government has to provide, coverage. The system must then
provide it.
Dr. Rosen:
Provide it when? In Canada they sometimes die in the interim.
Dr. Milton:
Now that's a way to save money.
Dr. Rosen:
That's the way America is also going. With 18 to 20 million more people being
dumped into Medicaid, that will decrease access.
Dr. Milton:
When Pew did their studies on 47 million people who don't have insurance, they
subsequently found out that most people on Medicaid said they didn't have
coverage. With an extra 30 million Medicaid patients saying they don't have "insurance," one can get to
40 million rather quickly.
Dr. Rosen:
People on Medicaid have such a hard time finding a doctor who will see them,
that they don't feel insured.
Dr. Milton: With
18 to 20 million more people in Medicaid, many will never find a doctor. I
guess that will make Paul feel better.
Dr. Paul: We
can solve that problem by forcing doctors to see them.
Dr. Milton:
Now wouldn't that be forced conscription, rather like a military draft?
Dr. Dave: Or
like the bank robber in a Western movie - holding a gun to the doctor as he
took his appendix out.
Dr. Rosen:
I've never understood that when I watched Westerns. If the doctor made a bad
cut, and the bank bobber shot him, wouldn't the bank robber be in a bad way?
Dr. Paul:
But the doctor would be in a worse way.
Dr. Sam:
Doesn't it look like the real debate is just beginning?
Dr. Milton:
The debate should have begun over a year ago.
Dr. Sam:
Remember Pelosi didn't want a debate on the issues. She just wanted to force
Socialized Medicine down our throat. Just like Medicare, once the public gets
to like it, it will never disappear.
Dr. Rosen:
Well, you see when we all lose our freedom; our civilization will be in a real
bad way.
Dr. Sam: And
health care will scrape the bottom of the barrel. Just like in Cuba.
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
The Staff Lounge Is Where Unfiltered Opinions Are Heard.
*
* * * *
8. Voices of Medicine: A Review of Local and Regional
Medical Journals
Peering over the Ether Screen - THE CSA BULLETIN - Winter, 2010
The Electronic Medical Record: Garbage
In, Garbage Out By Karen S.
Sibert, MD, Associate Editor
My first patient of the day
was a congenial man in his 50s with a history of prostate cancer and radical
prostatectomy, scheduled for replacement of a defective penile prosthesis. The
history and physical in his chart was a pleasure to read because it was printed
and legible, as opposed to the handwritten scrawls we often encounter. Imagine
my surprise, however, at reaching the section about this patient's previous
surgical history, and finding that he was supposed to have had none. I looked
twice to make sure I was reading it correctly. No prior surgery. Impossible, of
course—he had had both prostate surgery and the initial penile prosthesis placement.
Then I realized the obvious truth: We were sabotaged once again by the fatal
ease of data entry error in a computerized record.
Right now I'm not talking
about computerized anesthesia records—I have a few things to say about that
later, but for the moment I'm referring to the computerized documents that are
starting to appear in my hospital's charts.
Early problems surfaced with the "Medication Reconciliation"
form. It's good to know what medications your patients are taking, and when
they were taken last. Unfortunately, our nurses in preop holding, on the wards,
in the emergency department, and everywhere else, are deluged with paperwork
and computer documentation requirements. They can't be faulted for the
occasional typographic error, and there's no proofreading process. Yet, if the
patient took his beta-blocker this morning, but the nurse types in yesterday's
date by mistake, we will wrongly be "dinged" as noncompliant for
perioperative betablocker administration.
Worse still is the
potential propagation of errors in the patient's medication list. The other day we had two patients in preop
with the same, quite common, first and last names. Looking over the computer
printout of my patient's medications and seeing Keppra listed, I asked him if
he was doing well on Keppra and how long it had been since he had a seizure. He
looked puzzled. He didn't take Keppra,
he said, and to his knowledge had never had a seizure. We quickly figured out that the nurse had
merged his med list with that of the other "John Smith." That was the
easy part. The hard part was fixing the mistake. It turns out that once the
nurse "closes out" and prints the record, apparently it takes an act
of God to undo it. In the meantime, Keppra remains on the med list.
I think we can all agree
that we expect more of some H & Ps than we do of others. If the
gynecologist or the orthopedist has done the H & P, especially if it's a
"short form" for outpatient surgery, I don't pay a lot of attention
to the documentation of heart sounds. I'm a bit surprised if the existence of
the heart is acknowledged at all. But when a consulting internist performs the
preop H & P, especially if the patient is sick, we have every reason to
hope for better. Sadly, we may be
disappointed.
With handwritten H &
Ps, if parts of the exam were omitted, they would be left blank or
"deferred." Now, what we're seeing is a lot of documentation that may
or may not be true. Recently I've seen a normal cardiac auscultation documented
in the case of a patient who actually had a loud, harsh, aortic stenosis
murmur. If I can hear it, I assure you it wasn't subtle. The other night on
call, I was evaluating a patient for a cadaver kidney transplant and was
surprised to palpate a firm 3-cm. mass in the right side of her neck. The
primary physician and renal consultant both recorded the neck exam as
"supple, no masses or adenopathy." The surgeon had no choice but to
cancel the transplant and send the kidney to another recipient. The neck mass
needed proper diagnostic workup to rule out malignancy.
Such examples underscore
the fact that the mere presence of legible documentation doesn't make it
thorough or accurate. On a computer, it's perilously quick and easy to check
off a list of negatives, especially if they're all mandatory fields. This has
led me to develop the following guidelines for critical reading of the H &
P:
1. If a positive history or physical
finding is described, it's probably true.
2. If a negative history or normal finding
is documented, one of the following is true:
a. The
question was never asked or the exam never done.
b. It was
done in a hurry.
c. It was
done by someone in training who gets most clinical information from Wikipedia.
d. It was
done properly and is really negative.
3. A long list of negatives should be
viewed with suspicion unless the patient is an athlete under the age of 30.
At the ASA annual meeting
in October, I looked at the newest generations of automated anesthesia
record-keeping systems. There's no doubt in my mind that handwritten anesthesia
records should go the way of the quill pen. I don't want to chart vital signs
when there are perfectly good machines to do it for me, more accurately.
However, we will have to guard against the tendency to document trivia ad
infinitum just because it's easy to do.
. .
Back to my patient with the
penile prosthesis: Once I had determined that everything in his H & P was
going to require independent verification before it could be relied upon, I
took a longer look at the internist's recommendations for perioperative care. I
include them verbatim:
Pt
is at low risk for surgery. Please avoid shifts in Blood Pressure and Volume.
As is true with all surgery the anesthesiologist should mind the blood pressure
as this will reduce any unknown cardiac risk the patient may have. A profound
anemia would add further risk, which this patient has no evidence of. Should
heavier than expected bleeding occur, please keep Hct over 30 for further
cardiac risk reduction.
Although I don't know for
sure, I would bet money that this internist had a check-off list on his
computer with someone's idea of appropriate advice for the anesthesiologist.
How would I ever have managed the case without it? Is this really the quality
of information we can expect from a completely paperless system? Computers,
after all, don't generate content; they only store it and make it available for
retrieval. At the end of the day, if you put garbage in, you'll get garbage
out, and any time we thought we saved will be spent sorting through the trash.
Should we send this evaluation of the EMR to Obama? Or would it be futile to hit him with logic?
Read the entire article . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . .
.
VOM Is an Insider's View of What Doctors
are Thinking, Saying and Writing about.
*
* * * *
9. Book Review: Single Payer, Many Faults by Joseph Rago,
WSJ, March 12, 2010
Health Care Turning Point,
By Roger M. Battistella, (MIT, 165 pages, $21.95)
To hear President Obama
tell it, the health-care entitlement that Democrats are on the verge of passing
is the natural result of his pragmatic approach to government. Above the scrum
of politics, technocrats have convened their commissions, weighed the evidence,
and decided what works and what doesn't.
Yet these pragmatists—these putative servants of data and
dispassionate analysis—have somehow persevered through more than a year of
debate without ever acknowledging the core irrationality in American health care,
something that economists have spent decades begging the political class to
fix. Namely: "Because most consumers of health care are largely insulated
from directly paying for the services they use, health care is generally
perceived as an unlimited free good. . . . Wants and needs become insatiable
when care is believed to be free."
That is how Roger Battistella, an emeritus professor at
Cornell University, puts it in "Health Care Turning Point," his brief
for a "health policy paradigm in which pragmatism counts for more than
ideology." With admirable bluntness, Mr. Battistella dismantles a lot of
health-policy conventional wisdom, showing how it has been made obsolete by new
economic and social realities.
Mr. Battistella begins with the original sin of modern
American health care: the government's World War II-era decision that gave
businesses tax incentives to sponsor insurance for their workers but that did
not extend the same dispensation to individuals. Since third parties were
paying most of the bills—employers at first and eventually, with the creation
of Medicare in 1965, the government as well— no one had any reason to be
assiduous about controlling the cost of care. Patients always seemed to be
spending someone else's money.
Mr. Battistella is acute on the distorting effects of
such third-party arrangements. Health care, he writes, is one of the "most
backward sectors of the economy." It ignores "managerial and
corporate practices for attaining productivity and quality improvements."
Since no one is
scrutinizing the relation between costs and marginal benefits, for instance,
medical science has become ever more specialized and technologically
intensive—leading to unnecessary and overly costly procedures, in Mr.
Battistella's critique. And yet many of the doctors who dispense such
sophisticated care—say, taking a three-dimensional image of your brain—still
use handwritten paper records. Medical business models haven't capitalized on
economies of scale either: Almost half of U.S. hospitals have fewer than 100
beds, while one-fourth of doctors practice solo. Nor have providers reorganized
to manage chronic conditions, such as diabetes, which are better handled by
integrated teams than today's fragmented and uncoordinated system. And because
the income of doctors and the revenue of hospitals are rarely connected to the
quality of the care they provide, preventable errors—like infections acquired
in hospitals—may be the third leading cause of death in the U.S.
The solution, Mr. Battistella argues, is the "hidden
pragmatism of market competition." In a competitive environment, he says,
the "prosperity and survival" of caregivers would depend on
"outperforming one's rivals." Meanwhile buyers—that is,
patients—would be motivated to inform themselves and to "obtain the best
service at the lowest price." It sounds elementary, except that in
American health care it has never been tried. What would it look like? Mr.
Battistella imagines individuals free to buy a wide variety of insurance
coverage and choosing providers on the basis of transparent data about price,
quality and value. There would be a transition, but it could be as smooth as
the shift from defined-benefit pensions to 401(k)s.
Mr. Battistella
concentrates his salvos on "single payer" health care, the state-run
medicine that prevails in the rest of the Western world. Hospitals are owned by
the government; doctors are public servants; and care is funded by taxes but
rationed by limiting procedures that don't meet politically determined
criteria. It is an approach particularly unsuited to medicine, given the
biological variability of disease, the profusion of treatment options and the
diverse needs of individual patients: What works and what doesn't simply cannot
be the same for everyone. "The sheer complexity of real world
conditions," Mr. Battistella writes, "surpasses the capacity of
experts and their analytical models, regardless of how brilliant or
sophisticated they are."
Decentralized market competition is the best option
because, he says, "it depoliticizes responsibility for
decision-making." He is confident that trends are moving in a market-based
direction. That would be all well and good, as he patiently shows, but he is
far too sanguine on the political front. Mr. Battistella considers it progress
that few Democrats in recent years have openly advocated a European-style
single-payer system for the U.S. . .
Mr. Battistella confesses that he finds it "hard to
carry on a conversation with true believers," because their idea about
health care is "too deeply rooted in ideology." They simply don't
want to think about practical solutions, where markets do their best work.
There's no convincing some people—especially the supposed pragmatists now
pushing for de facto single payer in Washington.
Mr. Rago is a senior editorial page writer at
the Journal.
Printed in The Wall Street Journal, March 12,
2010, page A17
Read the entire book review . . .
To read more book
reviews . . .
To read book reviews
topically . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
*
* * * *
10. Hippocrates & His Kin: Short & Sweet
Discharge Note in a chart
He was hit
by a car on October 22, 2008 and in the Medical Center overnight for 19 hours.
He had innumerable x-rays and CT scans and all were normal including the knees
which was an area of trauma and his chest which was an area of concern
concerning Lingual abnormalities. He received a bill for $58,000 for these
19 hours. MediCal paid nearly $4000 of it.
Maybe the other $54,000 was Manna from
Heaven?
What Happens to Government Subsidies?
California's
nursing homes have received $880 million in additional funding from a 2004
state law intended to help hire more caregivers and boost wages. But 232 homes
did just the opposite. They either cut staff, paid lower wages or let caregiver
levels slip below a state mandated minimum, a California Watch investigation
has found. (Christina
Jewett & Agustin Armendariz, SacBee)
Has anyone ever seen government money end up where
the taxpayers thought it would?
How to reduce the deficit by 45
percent?
![[1publicpay]](./Apr1310_files/image002.gif)
http://online.wsj.com/article/SB10001424052748704281204575003101210295246.html#mod=todays_us_opinion
By eliminating premiums that state and
local governments pay above the private sector.
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
*
* * * *
11. Organizations Restoring Accountability in HealthCare,
Government and Society:
•
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. This month, read the informative An
International Trend Toward Self-Directed Care . . .
•
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. Just released: Let's Face It: Nobody Will Ever Fully Understand
This Bill . . .
•
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. This month, treat yourself to
Economics
for Yesterday, Today and Tomorrow . . .
•
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. This month,
you might focus on Compulsory
Insurance Has Consequences.
•
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?. This month, be sure to read House
Chairman Cancels Hearings on Obamacare's Costs . . .
•
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 at Healing
America: The
Free Market Instead of Government Health Care . . .
•
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. Read the latest
newsletter: On Sunday,
March 21st, the US House of Representatives passed what we call
"Obama-care." This is one of the darkest moments in American history.
The federal government has taken a large step towards control of our
healthcare, and with it control of our very bodies. The federal government is
taking away our decisions over health insurance and, unprecedented in history,
forcing citizens to purchase private products, ultimately under penalty of
incarceration. Read more . . .
•
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. This month, read Healthcare Reform Passes: Following months of heated public debate and aggressive
closed-door negotiations, Congress finally cast a historic vote on healthcare. It was truly a sad day on the House floor as we witnessed
further dismantling of the Constitution.
•
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. A free
and prosperous world through choice, markets and responsibility.
•
The
Heritage Foundation, www.heritage.org/,
founded in 1973, is a research and educational institute whose mission is 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. The Center for Health Policy Studies supports
and does extensive research on health care policy that is readily
available at their site.—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, they have lost site 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 The
Coming Constitutional Debate. The last ten years of Imprimis are archived.
* * * * *
Thank you for joining the
MedicalTuesday.Network and Have Your Friends Do the Same. If you receive this
as an invitation, please go to www.medicaltuesday.net/Newsletter.asp,
enter you email address and join the 10,000 members who receive this
newsletter. If you are one of the 80,000 guests that surf our web sites, we
thank you and invite you to join the email network on a regular basis by
subscribing at the website above. To subscribe to our companion publication concerning health
plans and our pending national challenges, please go to www.healthplanusa.net/newsletter.asp
and enter your email address. Then go to the archives to scan the last several
important HPUSA newsletters and current issues in healthcare.
Please note that sections 1-4, 6, 8-9 are entirely
attributable quotes and editorial comments are in brackets. Permission to
reprint portions has been requested and may be pending with the understanding
that the reader is referred back to the author's original site. We respect
copyright as exemplified by George
Helprin who is the author, most recently, of "Digital Barbarism,"
just published by HarperCollins. We hope our highlighting articles leads to
greater exposure of their work and brings more viewers to their page. Please
also note: Articles that appear in MedicalTuesday may not reflect the opinion
of the editorial staff.
ALSO NOTE: MedicalTuesday receives no government, foundation, or
private funds. The entire cost of the website URLs, website posting,
distribution, managing editor, email editor, and the research and writing is
solely paid for and donated by the Founding Editor, while continuing his
Pulmonary Practice, as a service to his patients, his profession, and in the
public interest for his country.
Spammator Note: MedicalTuesday uses many standard medical terms
considered forbidden by many spammators. We are not always able to avoid
appropriate medical terminology in the abbreviated edition sent by
e-newsletter. (The Web Edition is always complete.) As readers use new
spammators with an increasing rejection rate, we are not always able to
navigate around these palace guards. If you miss some editions of
MedicalTuesday, you may want to check your spammator settings and make
appropriate adjustments. To assure uninterrupted delivery, subscribe directly
from the website rather than personal communication: www.medicaltuesday.net/newsletter.asp.
Also subscribe to our companion newsletter concerning current and future health
care plans: www.healthplanusa.net/newsletter.asp
Del Meyer
Del Meyer, MD, Editor
& Founder
DelMeyer@MedicalTuesday.net
www.MedicalTuesday.net
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
Words of Wisdom
"It was the best of times, it was
the worst of times." - Charles
Dickens.
"You get the best out of others when you get the
best out of yourself." - Harvey Firestone: Tire
executive.
Goals . . . They've driven all progress for man since
the beginning of time. Without them, we would have shared the fate of the
dinosaur. www.nightingale.com/HomePage.aspx?promo=INTQ98v6
Some Recent Postings
Health Care: A
Two-Decade Blunder, by Tevi Troy . . .
HIPAA Revisited: Your
Medical Records Aren't Secure . . .
In Memoriam
Wolfgang
Wagner, custodian of the Bayreuth Festival, died on March 21st, aged
90
From The Economist print edition | Mar 31st
2010
THE very moment he came into the world, breech-born,
at Bayreuth, Wolfgang Wagner's life was mapped out for him. His aunts Eva and
Daniela, leaning over his cradle, could discern already "the
Master's" nose and chin, and imagine his baby lips babbling the prelude to
"Die Meistersinger". Growing up in his grandfather's house
(Wahnfried, or "peace from illusions"), his wrestling-ground was the
Master's grave in the back garden, his dressing-up costume a Nibelung's cloak
and horned helmet, and his playroom the prop-store at Richard Wagner's own
Festspielhaus on the green hill, among the wooden models of gods awaiting their
downfall.
But Wolfgang was the second son. This meant that
responsibility for the treasure of Bayreuth, the shrine built especially for
his grandfather's compositions and the annual festival devoted to them, was
bound to devolve to his elder brother Wieland. Everyone applauded Wieland's
"fabulous brilliance" at interpreting the works. Little brother
Wolfgang, on the other hand, was straightforward, practical and plodding. He
made a chicken run at Wahnfried, selling the eggs to his mother at market
prices. He liked the technicalities of sawing and hammering, pounding his own
anvil like the thieving dwarf Alberich of "Das Rheingold", and no job
around the Festspielhaus was too humble for him to do.
Underneath that easygoing surface, though, with its
thick Franconian inflections, ambition and resentment burned in Wolfgang's
breast. He went to war in 1939, getting hurt in Poland, while Wieland was given
a deferment for his genius. He was not included in Wieland's "fireside
chats" about festival planning, "evidently thinking he could achieve
better results by dispensing with my presence". And yet, from a stint at
the Berlin Staatsoper, he knew about staging musical dramas. As American bombs
began to pound Bayreuth in 1945, it was he who rescued the busts, pictures and
autograph scores from Wahnfried, stuffing them into rucksacks on his bike and
pedalling them to safety. And when the festival resumed in 1951, out of the
ruins, his commercial flair found, from somewhere, sponsors and money.
So when, in 1966, Wieland died suddenly, there was no
doubt in Wolfgang's mind that he should take over. Nor did he doubt that he
should sit there, crouched over the Festspielhaus like the dragon Fafner over
his hoard, until he died. No one else was remotely suitable. Certainly not his
meddling sister Friedelind, who had turned her back on Germany and skipped off
to America; not Wieland's pushy wife Gertrud, who had said
"defamatory" things about Wolfgang on television; not Wieland's son,
Wolf-Siegfried, who seemed to think he could drift into Bayreuth's top job
without hard work or training; nor, as the years rolled by, his own children
from his first marriage, the sniping Eva and that unspeakable leftist
"crackpot", Gottfried.
Bedtime with Hitler
Controlling Bayreuth, in Wolfgang's terms, was not
just a matter of organising directors, conductors, money and, in 1973 and 1986,
legal instruments to ensure that the family, meaning him, kept its grip on the
festival. He also had to keep the heritage pure. In fact he was not over-pious,
refusing to see his grandfather's sets, even for the sacred
"Parsifal", as holy relics; he ignored letters accusing him of
betraying German culture when he allowed a communist salute during
"Tannhäuser", or when a French "Ring" of 1976 put turbines
on the Rhine and turned the Rhine-maidens into whores. He liked to think of
Wagner's works as Greek tragedies, of fresh and universal human importance.
Nonetheless, because the Nazis had commandeered them,
and because most of the family had been only too happy to go along, there was
much purifying to be done. So Wolfgang hid away, in his motor-cycle sidecar in
the garage, the film he had shot of Hitler, known as "Uncle Wolf" to
him, happily strolling round Wahnfried in the 1930s. Presumably he buried
deeper the memories of Hitler telling bedtime stories. His mother's devotion to
"our blessed Adolf" remained acutely embarrassing; but Wolfgang, who
had never joined the Nazi party, proclaimed that he himself had nothing to
repent of. It was not his fault that Hitler had loved his family.
For himself, he loathed it. As long as his health
allowed, he kept them all at bay—save Gudrun, his second wife, who died before
him, and his daughter Kati, who now succeeds him. His life was not this
squabbling brood, but the ten operas and music dramas his grandfather had left
to the world. And though it could be argued that fiery Loge, foolish Wotan and
impetuous Siegfried were not much improvement on the Wagners, Wolfgang at least
controlled them. As the grasping antagonists sang on, gradually losing out to
the tubas and bass trombones, he could make the set yawn open and shut like the
giant circle from his 1970 "Ring" until, in the end, it swallowed
them whole. The world ended then; silence descended; and the stocky second son,
with his grandfather's profile, would stride onstage and take a bow.
Read the entire obituary . .
.
Feedback
. . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
On This Date in History - April 13
On this date in
1983, Harold Washington was elected 1st black mayor of
Chicago. Our
concern is to heal. Our concern is to bring together. That fallacy flies in the
face of studies that show, every day, in every way, things are getting a little
worse for America's minorities relative to the progress made by those in the
top percentiles of assets and income. www.brainyquote.com/quotes/authors/h/harold_washington.html
On
this date in 1980, U.S. boycotts Summer Olympics in Moscow.
On this date in 1933, the 1st flight over Mount Everest
was made by Lord Clydesdale. At 8,848 meters (29,029 feet), Mount Everest it
the tallest mountain in the world. Since Sir Edmund Hillary's legendary ascent
to the peak of Mount Everest in 1953, over 3,700 people have successfully made
the difficult and dangerous climb. While both Chinese and the Nepalese people
always claim that Mount Everest (and its peak) belongs to their respective
countries, the world's tallest mountain actually straddles the border of China
and Nepal.
On this date in 1929, my Brother,
the Rev Dr. Eldor W. Meyer, was born.
He lives in Girard, Kansas, with most of his extended family nearby. Happy 81st Birthday, Bro. May
you have many more.
After Leonard and Thelma Spinrad
Don't forget that 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, or any
single payer initiative, was born for the benefit of the state and of a
contemptuous disregard for people's welfare.