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MEDICAL TUESDAY . NET |
NEWSLETTER |
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Community For Better Health Care |
Vol IX, No 2, April 27, 2010 |
In This Issue:
1.
Featured Article:
How
the Brain Keeps Tabs on Two Tasks at Once
2.
In
the News: Sex Hormone
Boosts Thinking in Some Women
3.
International Medicine: NHS bosses earn large bonuses on
top of their six-figure salaries
4.
Medicare:
Medicare's Chief Actuary releases his evaluation of ObamaCare
5.
Medical Gluttony:
Patient Gluttony because no Doctor or Nurse explained it to the patient
6.
Medical Myths:
Only politicians can get away with subterfuge
7.
Overheard in the Medical Staff Lounge: MUDA, MURA, MURI
8.
Voices
of Medicine: Life
Without Lawyers by Philip Howard
9.
The Bookshelf: The More, The Better
10.
Hippocrates
& His Kin: Three sources of income, but Uncle Sam can only find two of them
11.
Related Organizations: Restoring Accountability in Medical Practice and Society
Words of Wisdom,
Recent Postings, In Memoriam . . .
* * * * *
Always remember 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.
* * * * *
1. Featured Article: How the Brain Keeps Tabs on Two Tasks at
Once
Motivated Multitasking: How the Brain Keeps Tabs on
Two Tasks at Once, By Katherine
Harmon, Scientific
American, April 15, 2010
New research shows that rather than being
totally devoted to one goal at a time, the human brain can distribute two goals
to different hemispheres to keep them both in mind--if it perceives a worthy
reward for doing so
The human
brain is considered to be pretty quick, but it lacks many of qualities of a
super-efficient computer. For instance, we have trouble switching between tasks
and cannot seem to actually do more than one thing at a time. So despite the increasing
options—and demands—to multitask, our brains seem to have trouble keeping
tabs on many activities at once.
A new study, however,
illustrates how the brain can simultaneously keep track of two separate goals,
even while it is busy performing a task related to one of the aims, hinting
that the mind might be better at multitasking
than previously thought.
"This is the first
time we observe in the brain concurrent representations of distinct
rewards," Etienne
Koechlin, director of the cognitive neuroscience laboratory at the French
National Institute for Health and Medical Research (Inserm) in Paris and
coauthor of the new study, wrote in an email to ScientificAmerican.com .
. .
For the study, 32
right-handed subjects were asked to match letters while their brain activity
was recorded with functional magnetic resonance imaging (fMRI). Subjects were
motivated by a monetary reward they would receive based on how many letters
they matched without error. During this baseline test, both hemispheres of the
brain's medial frontal cortex (which is involved in motivation) appeared
active. However, when the researchers introduced a second task, where the
subjects had to match like uppercase letters in addition to matching like
lowercase letters with separately accruing reward tallies, Koechlin and his
coauthor Sylvain Charron (of the same institution) found that the subjects'
brains divided the two reward-based goals between the two sides of the region.
The results were published online April 15 in Science.
The area of the brain
that was highly active in the observed multitasking behavior, the frontopolar
cortex (which organizes pending goals while the brain completes another task),
is "especially well developed" in humans, Koechlin says. It helps
organize tasks and the order in which their components should be completed (as
highlighted by patients who have damaged this part of the brain and are
especially poor at multitasking, he notes). This area's lesser development in
other primate species leads Koechlin to think that the ability to hold more
than one goal in mind at once might be unique to our species.
The new work does not,
however, show that the brain can actually execute two distinct tasks, such as
letter matching, at precisely the same time, Paul Dux a psychology lecturer
at the University of Queensland in St. Lucia, Australia, noted in an email to ScientificAmerican.com.
The data reveal that though separate goals might be running concurrently in the
brain, "there are still large dual-task costs" when people have to
switch between two tasks making for "non-efficient multitasking,"
cautioned Dux, who was not involved in the new research but has also studied
attention in the brain. (Some commonplace activities, such as driving and
talking on a cell phone frequently go hand-in-hand, but the brain is likely
switching its main focus quickly between the two activities, perhaps a reason the
pairing has been so dangerous.)
Although the
letter-matching tasks were simple, Koechlin says that the same hemisphere split
would also likely be observed in subjects performing more complex tasks.
"Task complexity itself does not prevent from dual-tasking," he
explains. "People should be able to switch back and forth between two
complex tasks (by postponing one while executing the other one), provided that
the incentive of pursuing each task is large enough." If one of the tasks
sparks too many unrelated thoughts, however, "your frontal lobes should
lose track of one task," he notes (perhaps providing more evidence for the
hazards of distracted
driving).
Within the results of Koechlin's work is an explanation for why people tend to prefer binary options, such as yes-or-no questions and if-then statements. "This finding further suggests that the frontal function cannot keep track of more than two goals/tasks at the same time," Koechlin explains. "Humans have problems deciding between more than two alternatives…. A possible explanation is that they cannot keep in mind and switch back and forth between three or more alternatives."
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* * * * *
2. In the News: The sex hormone boosts thinking in some
women, impairs it in others
By Erik Vance, Scientific American,
April 2010
Big test coming up? Having trouble concentrating? Try
a little estrogen.
Neuroscientists at the University of California,
Berkeley, report in a recent study that hormone fluctuations during a woman's
menstrual cycle may affect the brain as much as do substances such as caffeine,
methamphetamines or the popular attention drug Ritalin.
Scientists have known for decades that working memory
(short-term information processing) is dependent on the chemical dopamine. In
fact, drugs like Ritalin mimic dopamine to help people concentrate. Researchers
have also had evidence that in rats, estrogen seems to trigger a release of
dopamine. The new study from Berkeley, however, is the first to show that
cognition is tied to estrogen levels in people—explaining why some women have
better or worse cognitive abilities at varying points in their menstrual
cycles.
The Berkeley team examined 24 healthy women, some of
whom had naturally high levels of dopamine and some of whom had low levels, as
indicated by genetic testing. As expected, those with the lower levels
struggled with complicated working memory tasks, such as repeating a series of
five numbers in reverse order. When the test was repeated during ovulation,
however, when estrogen levels are highest (usually 10 to 12 days after menstruation),
these women fared markedly better, improving their performance by about 10 percent.
Surprisingly, those with naturally high dopamine levels took a nosedive in
their ability to do complicated mental tasks at that point in their cycle . . .
"There are pretty important differences,"
Jacobs says. "And until we figure out how they differ in a normal state,
we can't predict how they differ in a diseased state." [For more on sex
hormones in the brain, see "Different Shades of Blue) (Women get sad. Men
get mad. Depression comes in many hues)
Read
the entire article. . .
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* * * * *
3.
International
Medicine: NHS boss
earned Ł68,000 in bonuses - on top of six-figure salary
Liberal Democrat probe
forces bodies to reveal 'scandalous' bonus culture in NHS
Denis Campbell
and Eleanor Harding,
TheObserver – Guardian.co.uk
NHS bosses are earning annual
bonuses of tens of thousands of pounds on top of their six-figure salaries, the
Observer can reveal today. Anna Walker, chief
executive of the Healthcare Commission, got Ł68,000 in bonuses.
Hundreds of chief
executives, departmental directors and board members of hospitals and other NHS
organisations have received extra payments of as much as Ł32,000 – the largest
single year's bonus unearthed by freedom of information requests submitted by
the Liberal Democrats. .
.
Anna Walker, who was chief
executive of the Healthcare Commission until it was disbanded last year, earned
the largest combined amount in the past three years – Ł68,150 on top of her
six-figure salary. She received Ł22,375 in 2006-07, Ł23,000 in 2007-08 and
Ł22,775 in 2008-09 for running the then NHS watchdog in England.
Norman Lamb, the Lib
Dems' health spokesman, condemned the payments as shocking. "These bonuses
are utterly scandalous. People will be disgusted by the extent to which fat
cats in the public sector have been enriched at a time when the NHS has denied
people drugs that they need and access to treatments such as in mental
health," he said. "We thought it was just in banking, but the
unacceptable bonus culture appears to be alive and kicking in the upper echelons
of the NHS."
This is the first time
both the number of bonuses and their size has been disclosed. The Lib Dems
sought information from every hospital trust, primary care trust (PCT), mental
health trust and ambulance service in England, as well as other NHS bodies such
as strategic health authorities. While some pay no bonuses, many do. However,
the figures do not reveal the full picture because some refused to disclose
theirs and a few simply gave their chief executive's salary band. . .
South Essex trust spokeswoman
Maxine Forrest, said: "In 2008-09, to recognise the trust's exceptional
performance in national ratings, a one-off bonus was paid. Dr Patrick Geoghegan
is chief executive of one of the most successful and highest-performing NHS
organisations in the country.". . .
The chief executive of
the Royal Berkshire hospital trust received Ł54,611 in bonuses over three years
in 2007-09, while the chief executive of the Human Tissue Authority was given
Ł37,895 in 2006-09.
Many chairmen, divisional
directors and both executive and non-executive directors of NHS bodies also
receive bonuses. The Royal Berkshire hospital trust spent Ł240,728 on bonuses
in 2007-09, more than any other NHS body that provided figures. Eight executive
directors shared another Ł186,117, as well as the Ł54,611 payment to the chief
executive.
Large payments to senior
figures in those three years were also made by the Healthcare Commission
(Ł215,550), the London Ambulance Service (Ł130,646), the Hertfordshire
Partnership mental health trust (Ł122,465) and Portsmouth Hospitals (Ł105,000).
All three main parties
have pledged to slash NHS management and bureaucracy. "This is the first
real analysis of the bonus culture at the top of the NHS, and it's
shocking," said Lamb. "Bonuses of Ł20,000 or more are more than many
NHS staff receive as their full year's salary."
■ Two out of three
people believe patient care will suffer if the NHS in England has to make the
Ł20bn of savings it has been told to find over the next few years.
A new poll on attitudes
to the NHS also reveals that the public see it as the third-most important area
for spending by the next government. The economy emerged as the top priority
(49%), then immigration (12%) and health (11%), ahead of law and order (7%) and
education (6%), according to a poll of 4,486 UK adults conducted by YouGov for
the Royal College of Nursing. All three main parties have pledged to protect
NHS frontline services, although NHS chief executive Sir David Nicholson has
warned that Ł20bn will have to be saved in England between 2011 and 2014 CN's
general secretary, said: "We are already seeing short-sighted cuts, for
example in vital specialist nurse posts."
Lib Dems call for tighter rules on foreign doctors
17 Sep 2008
Liberal Democrats conference: Government in 'conspiracy
of silence' over mental health
12 Sep 2008
guardian.co.uk © Guardian News
and Media Limited 2010
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Government
medicine covers up scandals for years before the taxpayers find out
* * * * *
4. Medicare: Medicare's Chief Actuary releases his
evaluation of ObamaCare
Health Alert | Obama
Administration Report is a Devastating Critique of ObamaCare
by John Goodman, Apr 26, 2010
Rick Foster is my hero. Over the past year, he has
proved over and over that he cannot be bullied, intimidated, threatened,
cajoled, browbeaten, buffaloed, hornswaggled, seduced, tricked, duped,
bamboozled, bribed, blackmailed, coerced or bought off. In a place like Washington,
D.C., this means that most days he probably eats lunch alone. It's amazing that
he still has his job.
Rick Foster is the Chief Actuary of Medicare, and his
office has just released a devastating
critique of the Administration's health reform law.
Before getting to details, let me say there is nothing
in the report that is surprising to independent health economists. The
conclusions are consistent with everything The
Lewin Group and other private estimates have been saying for months. What
is surprising is that one of the most respected agencies of the U.S. government
is completely undermining the Alice-in-Wonderland fables being spun by the
White House, on Capitol Hill and in the mainstream media. To wit:
- You cannot take close
to one trillion dollars away from one group of people and spend it on
another group of people and somehow leave those footing the bill better
off.
- You cannot give
millions of people large increases in medical care without creating any
new doctors, new nurses or other paramedical personnel.
- You cannot arbitrarily
reduce what you are paying providers by billions of dollars and still
expect to get the same quantity and quality of care.
- You cannot give
millions of patients and thousands of doctors new incentives to waste
medical resources and then expect health care spending to go down.
In other words, the Chief Actuary is simply saying
reality is reality. Economics is economics. A is A. Here
are the salient findings (with page numbers in the Actuary's
report):
- Health care
costs will go up, not down.
National health expenditures will increase from 17 percent of GDP now to
21 percent under the new law and will be higher than without the
legislation. [Page 4] Net federal spending on health care will also
increase.
- Health care
shortages are "plausible and even probable." Because of the increased demand for health care,
"supply constraints might initially interfere with providing the
services desired by the additional 34 million insured persons." [Page
20]
- 14 million
employees will lose their employer coverage. Employees of small firms are especially at risk
(despite small employer tax credit subsidies). [Page 7]
- 2 million
employees who lose coverage will have to enroll in Medicaid. [Page 3]
- A Medicaid
insurance card is not a guarantee of care. An estimated 18 million people will be added to
Medicaid. [Page 3] However, because there is no corresponding increase in
the supply of caregivers, "it is reasonable to expect that a
significant portion of the increased demand for Medicaid would be
difficult to meet, particularly over the first few years." [Page 20]
- One in ten
insured workers will see their health benefits taxed. By 2019, more than 10% of insured workers will
"be in employer plans with benefit values in excess of the thresholds
(before changes to reduce benefits) and this percentage would increase
rapidly thereafter." [Page 13]
- Higher taxes
will lead to higher premiums.
The new taxes on medical devices, prescription drugs, and insurance plans
"would generally be passed on through to health consumers in the form
of higher drug and device prices and higher insurance premiums."
[Page 17]
- There are more
than one-half trillion in Medicare cuts. The new health law cuts "$575
billion" from Medicare. [Page 4]
- Medicare cuts
would threaten almost one in every seven hospitals. About "15 percent of Part A providers
would become unprofitable within the 10-year projection period."
[Page 10]
- Overall access
to care for seniors would go down. Because of the law's payment reductions, "providers for
whom Medicare constitutes a substantive portion of their business could
find it difficult to remain profitable and, absent legislative
intervention, might end their participation in the program. [Page 10]
- 7.4 million
people will lose access to Medicare Advantage plans. Enrollment in MA plans will be cut in half
(from its projected level of 14.8 million under the current law to 7.4
million under the new law). [Page 11]
- False
advertising: The new "Medicare Tax" doesn't go to Medicare. "Despite the title of this tax, this
provision is unrelated to Medicare; in particular, the revenues generated
by the tax on unearned income are not allocated to the Medicare trust
funds." [Page 9]
- False
advertising: Budgetary
double-counting does not improve Medicare's solvency. Medicare
cuts "cannot be simultaneously used to finance other federal outlays
(such as the coverage expansions) and to extend the [life of the Medicare]
trust fund, despite the appearance of this result from the respective
accounting conventions." [Page 9]
- The new
long-term care insurance plan (CLASS Act) is unsound. The program faces "a significant risk of
failure" because the high costs will attract sicker people and lead
to low participation. [Page 15]
- The promise to
those with pre-existing conditions is unfunded. "By 2011 and 2012 the initial $5 billion in
Federal funding for [high risk pools] would be exhausted, resulting in
substantial premium increases to sustain the program." [Page 16]
- The law does
almost nothing to limit actual fraud and abuse. The fraud provisions in the law will save only
about two
percent of $47 billion in suspect claims.
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Government is not the solution to our problems, government is
the problem.
- Ronald Reagan
* * * * *
5. Medical Gluttony: Patient Gluttony because no Doctor
or Nurse explained it to the patient
A
patient we had seen in the 1970s called last week because she was unable to
contact her personal pulmonologist in order to obtain oxygen. After two
consecutive evening ER visits, where she was told she did not need oxygen, she
was hopeful that I would be able to help her obtain it.
She said she had eight specialists to take care of
every organ of her body. But she was unable to get any help from any of the
eight.
From experience, it is well known that patients do not
think physiologically that there may be other causes of shortness of breath.
It's a knee-jerk reflex that if you're short of breath, you need oxygen. Did
she have asthma? She said no.
I consented to see her the next morning. When she came
in, my staff already had obtained copies of the ER visits that indicated that
her oxygen saturation was 97%, her chest x-ray and CT of the chest were
unremarkable. Her oxygen saturation was 97% again, but her lungs revealed some
wheezing. A whiff of albuterol promptly reversed that symptom.
She then brightened up. "That's the first good
breath I've had in nearly a week. Won't you be my doctor again?"
I had to beg off. With eight doctors already, she
should see if one of them would take care of her whole body, not just one
organ. She was advised that if she wanted a Personal Pulmonologist and another
appointment in our office, she would have to dismiss her other eight
physicians. It would be difficult to give appropriate medical care with eight
doctors each writing prescriptions.
Only with Government Medicine, whether Medicare or Medicaid, as this
patient had, can you have eight doctors to treat every organ and not one to
take care of the entire person.
Only with a personal physician that you pay personally will you have a doctor
you can depend on.
That's the reason government health care is up to eight times as expensive as
personal health care.
And that's why your taxes are going through the roof with ObamaCare.
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Medical Gluttony thrives in Government and Health Insurance Programs.
* * * * *
6. Medical Myths: Only politicians can get away with
subterfuge
AAPS Myth 19: The
American people are demanding "health care now."
Spokesmen for the Democrats' "health care
reform" proposals say that all those ordinary-appearing Americans waving
hand-made signs are either operatives of powerful vested interests, especially
insurance companies, or "political enemies" bent on destroying the
Obama presidency.
Even people in conservative Montana are strongly
supportive, and continue to adulate the President, according to mainstream
media coverage of a forum he held in Belgrade, MT.
But poll numbers suggest otherwise. The percentage of
people with "very negative" feelings about Obama has tripled since
the beginning of the year, hitting 20% nationally, 23% in those older than 65 (Jonathan
Weisman, Wall St J 8/20/09). Congressional approval ratings sit at
30% (Daniel
Henninger, Wall St J, 8/20/09). A poll conducted Aug 4-9 found
that 49% disapproved of Obama's handling of health care, and 43% approved (Washington
Examiner 8/14/09). Read
more . . .
Although the Obama campaign made extensive, skillful
use of the internet and social networking, David Axelrod, Senior Advisor to the
President, sent an email on White House letterhead complaining of "viral
emails that fly unchecked and under the radar, spreading all sorts of lies and
distortions."
The White House launched its own "chain
email" and a new website, http://www.WhiteHouse.gov/realitycheck.
AAPS has been hearing complaints from people who received "spam" from
the White House, wondering how the White House got their email address. After a
"riotous" response to the snitch mailbox for "fishy"
misinformation, flag@whitehouse.gov, the government disabled it. "Reality
check" might serve the same purpose.
Who is pushing the Democrats' proposals? The people
with the bullhorns and professionally made signs appear to be bussed-in, paid
agitators from unions or left-wing advocacy groups. The town-hall meetings held
by the Administration look "utterly stacked," writes Peggy Noonan (Wall
St J 8/15-16/09).
Read the entire posting at
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Medical Myths Originate with Government Playing Politics.
Myths Disappear When the Voices of Ordinary People are Heard.
* * * * *
7. Overheard in the Medical Staff Lounge: MUDA, MURA, MURI
MUDA
is a traditional Japanese term for an activity that is
wasteful, doesn't add value or is unproductive.
MURA is a traditional general Japanese term for unevenness,
inconsistency.
MURI is a traditional Japanese term for overburden,
unreasonableness or absurdity.
Dr. Rosen: Today I observed my office assistant spending four
hours making copies of a number of office charts, each spanning two or three
years, to send to the insurance carrier.
Dr. Dave: I wouldn't do that. I'd tell the company to fly a
kite.
Dr. Rosen: My assistant says they have a legal right to request
copies of up to ten charts a year so they can review the quality of care and
determine if the payment is appropriate. If they want more, they obtain a
service to do the copying. So, they always request less than ten records
because they get the copies for free.
Dr. Dave: You must work for an HMO. I don't take that kind of a
patient.
Dr. Edwards: I'd say several different insurance companies are
requesting them under the HIPAA (Health Insurance Privacy and Accountability
Act) laws where patients, ironically, lost their privacy, the "P" in
HIPAA.
Dr. Rosen: Doctors lost the ability to keep patients' records
confidential when patients had the feeling that if it weren't for the
government protecting their privacy, doctors might even publish a patient's
record.
Dr. Sam: These medical bureaucrats have no idea how
confidentiality and privacy are drilled into every medical student so that it
becomes their middle name.
Dr. Paul: Don't you think that it is important that records
are kept private?
Dr. Sam: Yes I do. But HIPAA didn't do it. The medical records
were more confidential before HIPAA.
Dr. Paul: How do you figure?
Dr. Sam: Before HIPPA, no one got the patient's record unless
the patient signed for it. Now, every government agency, Medicare, Medicaid,
and every insurance company has access to the patient's record. Some even
request that we not tell the patient we made copies of their record. That just
creates problems we'd rather avoid.
Dr. Edwards: Before HIPAA, doctors who were involved in caring for
the patient were able to obtain the patient records as needed for care. Now
it’s not unusual the doctors that care for the patient have to obtain the
patient's permission to obtain records from the hospital after discharge since
the hospitalist takes over the inpatient care.
Dr. Rosen: All of this unnecessary work falls so neatly into
the Japanese term, MUDA, that describes most bureaucratic work - extra totally
unproductive work producing waste.
Dr. Sam: When are doctors going to rise up and say enough is
enough!
Dr. Rosen: When we have our professional societies with enough backbone
to say so. But national, state and local medical societies frequently have
socialistic staff that keeps the wheel greased for the government takeover of
medicine.
Dr. Sam: And then the patients will have lost their last real
advocate.
Dr. Milton: There will have to be a quiet revolution in medicine.
We have to do it before we become even more fragmented as more sections in
medicine give up their resistance to the government takeover.
Dr. Rosen: That will be the day that MUDA, MURA and MURI totally
paralyzes us with busy, non-productive work that adds no value to health care,
is wasteful, inconsistent, unreasonable, and totally eliminates the beneficial
aspects of what we do in life. Then we'll be back in the fifteenth century,
having to start over along the road to freedom.
Dr. Milton: Another 500-year journey that doesn't need to be.
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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
* * * * *
8. Voices of Medicine: A Review of Local and Regional
Medical Journals
Sonoma
Medicine, an award-winning quarterly magazine. Volume 66, Number 2 - Spring 2010
A Country Burdened by Law By John Toton, MD
Dr.
Toton, a Healdsburg orthopedic surgeon, serves on the SCMA Editorial Board
Life Without Lawyers by Philip Howard, 225
pages, Norton, $16.
The title Life
Without Lawyers will catch your browsing eye, but the subtitle is more to
the author's point: Liberating Americans From Too Much Law.
Philip Howard, JD, is a partner in
Covington & Burling, a legal firm in New York City, and a graduate of Yale
University and the University of Virginia School of Law. . . He is also a leading advocate of legal reform,
and writes and speaks extensively on the topic of "Too much law is
suffocating America."
Life Without Lawyers is Howard's third book, following The
Death of Common Sense (1995) and The Collapse of the Common Good
(2002). His recent article in the Wall Street Journal (15 October 2009),
"Why Medical Malpractice Is Off Limits," speaks directly to the $200
billion spent annually on "defensive medicine." In the article,
Howard focuses on the trial lawyers' arguments that they alone are "the
bulwark against ineffective care." They have lobbied so effectively with
the party in power that malpractice reform, even pilot projects such as
specialized health courts, is off the table.
Life Without Lawyers, however, focuses not on medical reform,
but rather on the deep legal hole we've gotten ourselves into, in every walk of
life.
In America, says Howard, teachers cannot
teach. Attempting to teach demands that teachers spend almost half their time
and effort trying to control an unruly class or student. Teachers have little
or no authority to enforce discipline: a student cannot be "touched"
and commonly cannot even be removed from the classroom. As a result, one
student can subvert the learning experience of the other 20 to 30. School
principals are ineffective, paperwork overwhelms, and fear of lawsuits brings
the teaching profession to its knees. As Howard asks, "What has become of
the common good, when one disruptive student has the effect of paralysis in the
education of the many?"
Outside the classroom, observes Howard,
many playgrounds, swimming pools and parks are closed because someone might get
hurt and sue the school, the church, the city or the state. Ironically, even as
we focus on childhood obesity, we are removing swings, slides, monkey bars and
see-saws from playgrounds for reasons of "potential harm." Both
children and adults can recognize that "there's no fun there"
anymore. Children are limited from exploring their neighborhoods and expanding
their boundaries because there might be evil, trouble and certainly risk in
such unprotected activity. Need we wonder why our children are becoming couch
potatoes?
Howard laments how the character of
America has changed, both the politics and the nature and expectations of the
people. As a nation we are no longer the independent, individualistic risk
takers who made our land a place to which people immigrated for the
opportunities and freedoms of self-expression. The country that Alexis de
Tocqueville so admired in the 1800s no longer exists. It has been replaced with
a persistent concern that our "free speech" might insult someone,
that we might suffer some offence, intended or not, and that our daily lives
are driven to protect ourselves from some accusation that would bring us into
the legal system.
"Encounters with the American justice system are a
nightmare," Howard writes. "Litigants live for years under the dark
cloud of hyperbole and accusation. Justice, American Style, is a formula for
exhaustion and fear, not trust." A 2005 survey found that only 16% of
Americans trust the justice system's ability to resolve a baseless claim or
accusation appropriately in their favor. . .
Howard offers an agenda for change,
embodied in his Principles for Daily Freedom:
- Restore
judges' authority to set legal boundaries so confidence in justice will be
reliable.
- Redefine
"rights" and also define "boundaries."
- Liberate
teachers from bureaucracy.
- Government
positions are identified as possessing responsibility, authority and
accountability.
- Balance
official decisions on common good, not individual dissatisfaction.
- Engage
citizens in active community leadership.
- Organize
local civic leadership; Washington is paralyzed.
Howard speaks out for real change in both
our litigious society (the most litigious in the world) and our leaders who no
longer lead. In his view, American culture is deteriorating as we look out for
our self-interest and are unwilling to take personal and civic risk, especially
in our interaction with others, fearing the threat of law. We clearly have too
much law, controlling our every action. This is not the America Howard wishes
on himself or on us.
Howard presents a compelling book that
encourages our thoughtful consideration. I encourage all to read it. It will keep
you turning the pages, no matter your starting point on this issue.
Read the entire
review . . .
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VOM
Is an Insider's View of What Doctors are Thinking, Saying and Writing about.
* * * * *
9. Book Review:
The More, The Better, By Nick
Schulz, WSJ, March 24, 2010
The Next Hundred Million, By Joel
Kotkin, (Penguin Press, 308 pages, $25.95)
A gloomy mood
might seem to be justified at the moment. Unemployment is nearing 10%. We have
just witnessed a bitter financial crisis, a series of debt-deepening bailouts
and a bruising fight over health care. Conservatives fret that we're running
out of time to tackle the entitlement crisis. Liberals fret that we're running
out of time to tackle the climate crisis. Roughly 60% of poll respondents say
that America is on the wrong track. Meanwhile, China has resumed its torrid
economic growth and has become for the U.S. what Japan was in the 1980s—the
seemingly unstoppable Asian force that will soon leave America's economy
behind. . .
"In
stark contrast to its rapidly aging rivals," Mr. Kotkin writes in
"The Next Hundred Million," "America's population is expected to
expand dramatically in coming decades." He points to a slowly rising birth
rate and to the continuing in-migration of young workers from poorer countries.
Most of America's population growth between 2000 and 2050, he notes, "will
be in its racial minorities, particularly Asians and Hispanics, as well as in a
growing mixed-race population." No other developed country, he says,
"will enjoy such ethnic diversity."
For Mr. Kotkin, population growth translates into
economic vitality—the capacity to create wealth, raise the standard of living
and meet the burdens of future commitments. Thus a country with a youthful
demographic, in relative terms, enjoys a big advantage over its global
counterparts. In the next four decades, Mr. Kotkin observes, "most of the
developed countries in both Europe and Asia will become veritable old-age
homes" because of stagnant population growth. And the economies of these
countries, already devoted to a vast welfare-state apparatus, will face
crushing pension obligations—but without the young workers to defray the cost.
Inevitably,
Europe and Asia will decline, Mr. Kotkin predicts, and America will thrive.
Indeed, the U.S. will emerge, he says, "as the most affluent, culturally
rich, and successful nation in human history." What about the
billion-person behemoth across the Pacific? Not to worry. Mr. Kotkin thinks
that, by midcentury, China's one-child policy will cause it, too, to suffer
from the burdens of an aging population. . . .
Mr. Kotkin's vision of America's next four decades—expanding, browning,
adapting and thriving—is largely convincing. He's no Pollyanna, however. He
worries especially that upward mobility is more difficult than it once was and
that class polarization is a real possibility, because a knowledge economy like
America's tends to widen class divisions. The result is "an expanding
affluent class of the highly educated, a stubbornly impoverished population,
and a shrinking middle class."
Here is one
area where Mr. Kotkin might have said more. The collapse of the family in
America's underclass persists—with more families than not headed by single
mothers. Mr. Kotkin is delighted to report that the family in America is taking
ever new shapes, adapting and "resurging" in different forms. This
claim may well be true for the broad middle class. But in that stubbornly
impoverished sector, the family isn't resurging at all. America's relatively
high birthrate—a source of national strength generally, as Mr. Kotkin
says—contains a large percentage of out-of-wedlock births. In some urban
neighborhoods, the rate stands close to 70%. The most "successful nation
in human history" still has some work to do.
Mr. Schulz is
editor of American.com, the Journal of the American Enterprise Institute, and
co-author of "From Poverty to Prosperity" (Encounter, 2009).
Printed in The Wall Street
Journal,March 24, 2010, page A15
Read the entire book review . . .
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reviews . . .
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The
Book Review Section Is an Insider's View of What Doctors are Reading and
Thinking about.
* * * * *
10. Hippocrates & His Kin: Three sources of income, but Uncle Sam can only find two of them
Staff, pay cut
despite new funds
By
Christina Jewett and Agustin
Armendariz, California
Watch, Monday, April 19, 2010.
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. The homes that made these cuts collected about $236 million
through 2008, the last year of available data. That's more than a quarter of
the total Medi-Cal funding
increase shared by the state's nursing homes.
The Report: www.sacbee.com/2010/04/19/2688050/staff-pay-cut-despite-new-funds.html#ixzz0nD9iox1J
Free money
seldom benefits the intended - only those that obtained the contracts.
Three sources of income but
Uncle Sam can only find two of them.
A retired military patient, when giving his employment
during an internal medicine history, stated that he was an appraiser, but did
all his work only for cash. Why only cash? Since he was a retired military
officer on a pension plus Social Security, he just couldn't afford to pay more
taxes.
Looks like the underground economy is booming!
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Hippocrates
and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Today & Tomorrow
* * * * *
11.
Professionals Restoring Accountability in Medical Practice, Government
and Society:
•
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. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
•
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. I
also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT
THE TIME OF SERVICE. 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."
•
Dr Vern Cherewatenko concerning success in restoring private-based
medical practice which has grown internationally through the SimpleCare model
network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service,
the "Cash-Based Revolution." The patient pays in full before leaving.
Because doctor charges are anywhere from 25–50 percent inflated due to
administrative costs caused by the health insurance industry, you'll be paying
drastically reduced rates for your medical expenses. In conjunction with a
regular catastrophic health insurance policy to cover extremely costly
procedures, PIFATOS can save the average healthy adult and/or family up to
$5000/year! To read the rest of the story, go to www.simplecare.com.
•
Dr David MacDonald started Liberty Health Group. To compare the
traditional health insurance model with the Liberty high-deductible model, go
to www.libertyhealthgroup.com/Liberty_Solutions.htm.
There is extensive data available for your study. Dr Dave is available to speak
to your group on a consultative basis.
•
Madeleine
Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in
health care, has died (1937-2006).
Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html.
She will be remembered for her
important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the
government's efforts in criminalizing medicine. For other OpEd articles that
are important to the practice of medicine and health care in general, click on
her name at www.healthcarecom.net/OpEd.htm.
•
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.
•
ReflectiveMedical Information Systems
(RMIS), delivering
information that empowers patients, is a new venture by Dr. Gibson, one of our
regular contributors, and his research group which will go far in making health
care costs transparent. This site
provides access to information related to medical costs as an informational and
educational service to users of the website. This site contains general
information regarding the historical, estimates, actual and Medicare range of
amounts paid to providers and billed by providers to treat the procedures
listed. These amounts were calculated based on actual claims paid. These
amounts are not estimates of costs that may be incurred in the future. Although
national or regional representations and estimates may be displayed, data from
certain areas may not be included. You may want to
follow this development at www.ReflectiveMedical.com.
During your visit you may wish to enroll your own data to attract patients to
your practice. This is truly innovative and has been needed for a long time. Congratulations
to Dr. Gibson and staff for being at the cutting edge of healthcare reform with
transparency.
•
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, who 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.
•
Dennis
Gabos, MD, President of
the Society for the Education of Physicians and Patients (SEPP), is
making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms
and Responsibilities of Patients and Health Care Professionals. For more
information, go to www.sepp.net.
•
Robert J
Cihak, MD, former
president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an
informative Medicine Men column at NewsMax, have now retired. Please log
on to review the archives.
He now has a new column with Richard Dolinar, MD, worth reading at www.thenewstribune.com/opinion/othervoices/story/835508.html.
•
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: Dr. Richard Amerling presents a proposal that if the
mandate to buy insurance survives constitutional challenges, individuals should
consider defying the mandate and not purchasing insurance. Why is opting
out a sound idea for patients? All third party payers limit
options. Limitations will by necessity become more stringent as the
system expands. The idea that "universal coverage" will make
everything available to everyone is absurd. Care is a finite resource and
it will be heavily rationed. Trading liberty for the illusion of
"free" care is a fool's bargain. Don't miss the "AAPS News,"
written by Jane Orient, MD, and archived on this site which provides valuable
information on a monthly basis. This month, be sure to read: Is the Individual Mandate Constitutional?
An individual mandate is essential to proposed reform. Funding depends on
forcing the young and healthy to pay enough to subsidize high-risk individuals,
and insurance industry support depends on the prospect of millions of unwilling
new customers. "Mandatory insurance is unconstitutional," write attorneys
David B. Rifkin, Jr., and Lee Casey (Wall St J 9/18/09). If Congress can
"tax" someone for being uninsured, it could also tax anyone who
failed to follow an order of any kind, they argue. If the mandate "falls
within Congress's power to tax and spend, no other constitutional authority is
necessary," writes Jack Balkin of Yale Law School (N Engl J Med
2/11/10). 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.
* * * * *
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"Your whole idea about yourself is borrowed -
borrowed from those who have no idea of who they are themselves." - Osho: Was an Indian mystic, guru, and philosopher
Slavery begins with mandatory volunteering.
"When you realize that prosperity is your divine
heritage, you should persist in claiming it." - Catherine Ponder: Author of books in the prosperity field
Some Recent
Postings
Read the HealthPlan
that will reduce health care costs and save Medicare for our seniors . . .
In Memoriam
Wilma Mankiller, first woman
chief of the Cherokee Nation, died on April 6th, aged 64
From
The Economist print edition | Apr 22nd 2010
ALL
through her life, white people tried to help Wilma Mankiller. As she walked to
school, two miles down the hilly, narrow lanes of north-eastern Oklahoma, women
in big cars would stop and offer her a ride. She didn't want one. The same
women would appear sometimes at the wood-frame house, where her family of 11
lived in three rooms, burning coal-oil and hauling water from the spring, and
offer them second-hand clothes. She would run away. If they caught her, they
would pat her on her black-haired, Indian head. "Bless your little
heart," they murmured.
In
1956, when she was ten, white people suggested her family should move from
their farm at Mankiller Flats to San Francisco. The government, having forced
her ancestors in 1838 along the Trail of Tears from eastern Tennessee to Indian
Territory, now promised them a better life even farther west. They caught the
passenger train from Stilwell; she wept Cherokee tears all the way to
California. No one had forced them out this time. But they ended up in a drab,
violent housing project where her father found back-breaking work in a
rope-factory and she was mocked at school for her stupid name. She knew it
meant "guardian of the settlement"; but that all seemed far away and
irrelevant now.
Many
years later, when she was principal chief of the Cherokee Nation, a white woman
offered money for college scholarships for Indians. She said she wanted to
"give pride back" to them. Ms Mankiller had never heard such arrogance.
Yes, her tribe needed schools, clinics, day care, Head Start programmes, and
all these she was busy procuring for them. But it did not need the patronising
charity of white people. Under Ms Mankiller, the Cherokee were learning to rely
on themselves again.
It
had taken time. Over the years the tribe had been absorbed until almost
everything was lost. In 1907 the tribal lands in Oklahoma had been broken up
into allotments, one of which was given to Ms Mankiller's grandfather at
Mankiller Flats; and nothing did more damage to the tribe, she believed, than
that loss of commonalty and spiritual, as well as physical, interdependence.
Her family had tried to preserve it, bartering with and working for other
people. But the Cherokee could not easily find their sense of oneness again.
She
herself was almost lost to the tribe for a while, married to a Latino at 17,
having two daughters early, living a middle-class Californian life. But the San
Francisco of the late 1960s gradually radicalised her. The stiletto heels were
swapped for sandals; the husband was sidelined; the two small daughters were
taken by boat to be part of the Native-American reclamation of the
prison-island of Alcatraz; and in 1976 she went back with them in a U-Haul van
to Mankiller Flats. There, on the land that was still her family's, they camped
under the stars and learned to tell the time by the sun, Cherokee-fashion. Nine
years later she was chief of the Cherokee Nation. . .
Read
the entire obituary . . .
On This Date in
History - April 27
On this date in 1822, Ulysses Simpson
Grant, was born in Point Pleasant, Ohio. He was born Hiram Ulysses Grant
and entered West Point mistakenly listed as Ulysses S. Grant and kept that name
and went on to fame for the rest of his life. He commanded the winning army in
the Civil War and was elected President of the United States in 1868. History
records his Presidency as, to put it kindly, undistinguished. Afterwards, in
private life, he was bilked by an investment company and spent the rest of his
life writing the memoirs that brought in enough money to pay off his debts and
make provision for his family. He was an honest man who reinforced the latent
American belief that good generals don't necessarily make good Presidents. It
was 66 years before another professional soldier, a man named Eisenhower, again
lived in the White House.
On this date in 1937, the U.S. Social
Security System made its first benefit payments. No one then or
perhaps even now fully understood the reversal of the Bill of Rights, which
protected us from the power of government abuse over millennia, to a reversal
of those rights to life, liberty and the pursuit of happiness into Civil
Rights, where the government usurps those rights, limiting and destroying our
freedom. We only have a brief window of opportunity to reverse this trend and
save our freedom for which our forefathers gave their lives or we'll become
like Europe, the land from which our forefathers fled.
After Leonard and
Thelma Spinrad