MEDICAL TUESDAY . NET
Community For Better Health Care
Vol XIII, No 5, Aug, 2013
In This Issue:
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The Annual World Health Care Congress
In April, the most forward-thinking health insurance, employer, hospital and health system executives and top health care thought leaders will come together to discuss transformative trends such as consolidation, transparency , quality metrics, engagement and procedural costs, payment model innovations.
Mention promo Code QPH357 and Save $300 off of the registration fee. Please take a moment to download the printable agenda (PDF).
As the national leadership forum to transform health care costs and quality, the 11th Annual World Health Care Congress www.worldhealthcarecongress.com drills down to find solutions to the challenges and issues facing health care executives in an unprecedented, peer-driven forum of open discussion and debate.
SEVEN dedicated, educational Summits provide focused presentations, along with interactive discussion on emerging trends and solutions. Join many organizations already sending their executive teams to cover all seven summits that include: www.worldhealthcarecongress.com
Health Insurer and Payer Summit for VP, SVP, and C-Level Executives
Health Reform & Policy Summit on Exchanges, Duals, Medicaid, & Medicare
Network & Contract Management Summit for Providers & Insures
Hospital, Health System & Physician Executive Summit for VP, SVP, C-Level Executives
Health Information & Technology Summit for Insurers & Providers
Business of Women’s Health Summit for Provider Marketing, Sales, & Strategy Executives
Benefits, HR, & Wellness Executive Summit on Improving Employee Engagement, Health, & Wellness
These Summits take place April 7-9, 2014, at the 11th Annual World Health Care Congress (WHCC) in National Harbor, Maryland – the only health care meeting that simultaneously convenes all stakeholders to share global strategies and offers targeted summits focused on each health care sector. Please take a moment to download the printable agenda (PDF).
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Featured Article: America’s Privileged Class
Andrew G. Biggs National Review, August 12, 2013
Pay for state and local government employees has gotten a great deal of publicity. Lost in the press attention, however, is that federal employee compensation remains a problem, too, and new data again indicate that Washington, D.C., may be overpaying for the 2 million workers it employs, says Andrew G. Biggs, a resident scholar at the American Enterprise Institute.
In a 2011 paper with Jason Richwine, Biggs concluded that federal workers receive salaries and benefits around 37 percent higher than do private sector workers with similar levels of education and experience. A study by the Congressional Budget Office, using slightly different methods, showed a smaller wage premium for federal workers, but still reached a qualitatively similar conclusion: Federal workers receive pay and benefits 16 percent above private-sector levels. Read more . . .
Data from the Organization for Economic Cooperation and Development (OECD) allows Biggs to compare how U.S. federal government employees are paid relative to central government employees in 18 other countries.
The OECD analyzed the salaries, benefits and paid leave for government employees; the combined value of these three categories equals total compensation. The OECD looked at four main categories of public employees:
Professionals. The OECD examined two specific professional positions, statisticians and economists/policy analysts.
Secretarial staff. This category is made up of two groups, senior/executive secretaries and office secretaries/general office clerks.
The key factor is benefits:
U.S. federal employees don't merely receive more generous benefits than do private-sector workers; they receive much more generous benefits than do public employees in most other developed countries.
The OECD data show that U.S. federal employees' total benefits add up to 37 percent of their wages, compared with 16 percent for central government employees in Australia, 25 percent in the Netherlands and Belgium, 27 percent in Great Britain, and 23 percent across the OECD as a whole.
Source: Andrew G. Biggs, "We're No. 1 -- In Public-Employee Pay," National Review, August 12, 2013.
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A statement by the Rev. Bart Day, executive director, Office of National Mission
Today the Supreme Court issued its ruling, striking down Section 3 of the Defense of Marriage Act (DOMA), allowing for federal benefits for legally married gay couples and potentially allowing for gay marriage in all of California with regard to Proposition 8. Though the ruling is not a surprise, we are saddened for our nation, even as we call our fellow Christians to faithfulness and prayer. Read more . . .
As Christians, we believe and confess that God Himself instituted marriage as the life-long union of one man and one woman. Same-sex unions are contrary to God’s will, and gay marriage is, in the eyes of God, no marriage at all. As Christians, we proclaim this truth, no matter what the courts or legislatures may say. We are called not to popularity but to truth. Therefore, we call on our fellow Christians to be faithful first to God’s Word, knowing that another court is ultimately supreme.
Marriage is a fundamental building block of society, binding parents to their offspring. Every child benefits from the nurture of a mother and the leadership of a father. While having one mother is a blessing, having two mothers or two fathers is confusing for the child and detrimental to her well-being. The divorce culture has done great harm to the institution of marriage as well, and The Lutheran Church—Missouri Synod (LCMS) has and will continue to respond to that heartache with Christ’s comfort while simultaneously working to restore a culture where marriage is upheld.
While this occasion reminds us that Scripture calls homosexuality sinful (see Lev. 18:22; 20:13; Rom. 1:24–27), the Bible also says plainly that those who “hunger and thirst for righteousness,” that is to say, those who repent and show genuine sorrow over their sin, are forgiven and loved by Christ.
And so as Christ’s Church, we forgive and love too, following His lead with compassion and humility. We forgive and love because we are all sinners in need of His grace and mercy; because no matter the sin, we have all rebelled against our Creator and fallen prey to unbelief; because He has justified us by grace through faith, freely given and joyfully received (Rom. 3:23–24); because Christ has reconciled us to the Father; because He has declared us righteous and we are.
In love, we will continue to teach marriage according to God’s plan and gift. We will continue to proclaim marriage as a picture of Christ’s love for His bride, the church. And we will continue to be a place of forgiveness, mercy and healing for all people, even as we will continue to proclaim God’s truth in love. As we move forward, we offer up our prayers for the nation and particularly for marriage, family and children.
Rev. Bart Day, executive
LCMS Office of National Mission
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International Medicine: The Cost of “Free Health Care” in Canada
August 16, 2013
Canadians often misunderstand the true cost of their public health care system. This occurs partly because Canadians do not incur direct expenses for their use of health care and partly because Canadians cannot readily determine the value of their contribution to public health care insurance, say Nadeem Esmail and Milagros Palacios of the Fraser Institute. Read more . . .
In 2013, the estimated average payment for public health care insurance will range from $3,387 to $11,381 for Canadian families, depending on the type of family.
For the average Canadian family, between 2003 and 2013 the cost of public health care insurance increased more than 1.5 times faster than the cost of shelter and clothing, more than twice as fast as food, and nearly 1.5 times faster than average income.
The 10 percent of Canadian families with the lowest incomes will pay an average of about $482 for public health care insurance in 2013.
The 10 percent of Canadian families who earn an average income of $56,596 will pay an average of $5,364 for public health care insurance, while those families that are among the top 10 percent of income earners in Canada will pay about $35,309.
One reason why Canadians don't know the true cost of health care is because physician and hospital services covered by tax-funded health care insurance are free at the point of use. This situation leads many to grossly underestimate the actual cost of the health care delivered. One often hears people speaking of "free" health care in Canada, which is a statement that entirely ignores the substantial taxpayer-funded cost of the health care system.
For example, health spending numbers are often presented in aggregate, resulting in figures so large they are almost meaningless.
For instance, approximately $135 billion in Canadian tax dollars were estimated to have been spent on publicly funded health care in 2012.
It is more informative to measure the cost of the country's health care system in per capita dollars: the $135 billion spent equates to approximately $3,870 per Canadian.
This would be the cost of the public health care insurance plan if every Canadian resident paid an equal share. Canadians certainly do not pay equal tax amounts each year, however. Indeed, some Canadians are children and dependents and are not taxpayers.
Source: Nadeem Esmail and Milagros Palacios, "The Price of Public Health Care Insurance," Fraser Institute, July 2013.
Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35,  1 S.C.R. 791
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August 14, 2013
Suffering from illness or injury? Good thing you're not British. U.K. police recently investigated the deaths of 300 patients at one hospital. The suspected cause is? Neglect. That could never happen in America, right? On the contrary. ObamaCare's new insurance exchanges and expansion of Medicaid represent the building blocks of a British-style, government-run health care system in this country, says Sally C. Pipes, president, CEO and Taube Fellow in Health Care Studies at the Pacific Research Institute.
If that system metastasizes, rationed care and subpar health outcomes will follow. Read more . . .
Less than four in 10 Americans say they support "single-payer" health care.
But the idea remains a hobbyhorse for many Democrats. A single-payer bill has been introduced in Congress every year since 2003.
Vermont Gov. Peter Shumlin (D) recently signed a single-payer bill into law. And former Congressman Anthony Weiner (D) is pushing for a citywide single-payer system as part of his campaign for New York City mayor.
Initiatives like these could lead to a piecemeal government takeover of the health care system. Consider ObamaCare's health insurance exchanges, which are scheduled to open for enrollment on October 1. Each was intended to be a state-run marketplace offering affordable coverage options. The exchanges haven't unfolded as planned.
Just 17 states are operating their own exchanges.
Seven states asked for federal help running their exchanges, and 27 left the task to the feds altogether.
So the federal government will soon effectively control the individual and small-group insurance markets in more than half the states.
Those markets won't function properly if people don't enroll. That outcome is looking increasingly likely. The exchanges are designed to take premiums from the young and healthy, who typically consume less care, to subsidize coverage for the aged. The individual mandate was designed to force these young folks to participate. But if they ignore the mandate, the exchanges will crumble.
Without young people's premiums to cover costs for older people, the insurance prices will skyrocket. The federal government may feel compelled to reduce premiums, or simply insure everyone directly.
Add the 13 million new Medicaid enrollees to the nearly 63 million people already enrolled and the 50 million people on Medicare, and more than 40 percent of the country will be on publicly financed insurance.
Source: Sally C. Pipes, "Is ObamaCare Paving the Way for Single-Payer System?" San Diego Union Tribune, August 1, 2013.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Medical Gluttony: Social Security Disability Insurance Costs More than Medicare
By Tad DeHaven, the Cato Institute, August 6, 2013
Social Security Disability Insurance (SSDI) is one of the largest federal programs; it is also one of the most troubled. The program's expenditures have doubled over the last decade, reaching an estimated $144 billion this year. Spending has risen so rapidly that SSDI's trust fund is projected to be depleted just three years from now, says Tad DeHaven, a budget analyst at the Cato Institute.
SSDI was originally created as a modest safety net aimed at severely disabled workers who were close to retirement age, but Congress has expanded benefit levels over the decades and eligibility standards have been greatly liberalized.
The result is that people capable of working are instead opting for the disability rolls when confronted with employment challenges.
Once on the disability rolls, experience shows that individuals are likely to remain there, which is bad for the individuals, taxpayers and the economy. Read more . . .
The process for determining eligibility for disability insurance benefits has become a bureaucratic nightmare.
Applicants often pursue a lengthy and litigious appeals process if their initial applications are denied.
And there is a growing reliance on subjective considerations in evaluating claims, which has exacerbated the difficult task of determining whether an individual is truly "disabled."
Specialty law firms working on a contingency fee basis have taken advantage of the complex system and its inconsistencies to reap a financial bonanza at taxpayer expense.
SSDI has become financially unsustainable and economically damaging, and policymakers should pursue major spending cuts to the program. They should also explore the potential to transition responsibility for disability insurance from the government to the private sector.
If Americans are not becoming less able to work because of health problems, why are the disability rolls increasing? Economists David Autor and Mark Duggan note that "the rapid growth of Disability Insurance does not appear to be explained by a true rise in the incidence of disabling illness, but rather by policies that increased the subjectivity and permeability of the disability screening process." Similarly, economist Richard Burkhauser calls the explosion in the number of people gaining federal disability benefits a "policy-driven epidemic."
Source: Tad DeHaven, "The Rising Cost of Social Security Disability Insurance," Cato Institute, August 6, 2013.
Medical Gluttony thrives in Government and Health Insurance Programs.
It Disappears with Appropriate Deductibles and Co-payments on Every Service.
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Medical Myths: Obama Care: The Truth; The Lies
Health Care: A new survey shows that ObamaCare is less popular with the uninsured than with the public. How is this even possible?
The January Kaiser Family Foundation health tracking poll shows that just 24% of the uninsured approve of ObamaCare. That’s down from 40% the month before the reform officially launched in October, and it’s a full 10 points below the public’s overall favorable rating.
Incredibly, more than twice as many uninsured say they’re worse off because of ObamaCare than say it’s helped. What’s more, just 7% of the uninsured say they tried to get coverage through an ObamaCare exchange. Nearly 60% say they hadn’t done anything to get coverage over the previous six months. Read more . . .
Given that Democrats claimed to have specifically tailored it to help the uninsured, these results make absolutely no sense.
Could it be that Democrats grossly misunderstood the population they were trying to help? Or had they’d been peddling lies about the uninsured population for so long — as a way to sell “universal health care” — that they’d come to believe their own propaganda?
It’s more likely the latter of the two. Despite the endlessly repeated mantra about 40-plus million uninsured, data have shown for decades the actual ranks of the uninsured were much smaller, and the population less helpless, than Democrats routinely claimed.
As IBD reported, 42% of the uninsured are either non-citizens, eligible for Medicaid, or actually enrolled in Medicaid. Another big chunk earns more than $75,000 a year. And the vast majority of those who lose insurance get it back within a year, about half within months.
Plus, various surveys find that only a tiny fraction — just 5% in the Kaiser survey — say they don’t have insurance because of poor health or age.
But admitting that the real uninsured problem is narrow would have undermined the Democrats’ goal of “comprehensive” health reform. So they routinely withheld such facts — as did the mainstream press, which is equally as enthusiastic about nationalized health care.
These facts help explain the relative indifference among the uninsured to ObamaCare. So far, only about 11% of those who signed up have been uninsured, although nobody knows for how long. The vast majority were just trying to continue coverage they had before ObamaCare came along.
Why should the uninsured bother? Other than threatening a modest tax penalty, ObamaCare gives them little reason to buy coverage. In fact, it practically begs them not to.
First, the plans are far too expensive, thanks to ObamaCare’s regulations, taxes, and benefit mandates. And the subsidies phase out quickly enough that many lower-middle class families will still find they can’t or don’t want to pay the costs.
Second, it won’t take long for those currently uninsured to realize that they are better off putting off the purchase, since ObamaCare guarantees they can get coverage after they get sick, and at subsidized rates.
And third, the law deliberately hamstrings the IRS’s ability to collect the tax penalty, making it a nearly worthless motivational tool.
Ironically, if the uninsured don’t show up at the exchanges, ObamaCare will expose the Democrats’ big lie about them. Then, perhaps, the nation could get busy enacting targeted, market-based health reforms that actually make insurance more affordable, more portable, and more attractive to those who don’t buy it today.
Medical Myths originate when someone else pays the medical bills.
Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.
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Overheard in the Medical Staff Lounge: Should Nancy Pelosi be prosecuted for malfeasance?
Dr Rosen: Is Obama Care in full swing now?
Dr. Milton: What is most amazing to me is how it even got to here. Didn’t Congress do due diligence on it?
Dr. Yancy: They haven’t even found one congressman or senator that’s admitted to having read the entire 2000 pages before voting.
Dr. Dave: Congress never does due diligence or we wouldn’t have so many unintended consequences after a bill is passed into law.
Dr. Ruth: I couldn’t believe that Nancy Pelosi admitted that she needed to have the bill passed so she could read it?
Dr. Yancy: Well I guess she didn’t want to waste her time if it didn’t pass? She must be one busy lady.
Dr. Rosen: But don’t we elect our representatives with the obligation to thoroughly research any measure before they make it the law of the land and force the citizenry to obey that law? Is it not Malfeasance in office not to even know the details of any bill that is passed? Isn’t that a prosecutable offense and grounds for impeachment?
Dr. Patricia: Rosen, you really make your point very clear about malfeasance. I just thought she was another incompetent member of congress. Yes, I think she should be prosecuted.
Dr. Joseph: Even though I’m retired, it pains me to see what’s happening to my profession. I think Nancy Pelosi demonstrates medical Illiteracy and incompetence.
Dr. Milton: You got that right, Joe. And so does our HMO which treats us as if we haven’t even graduated from Medical School with the mundane things they force us to do. One month they want us to give them the cholesterol levels of all our patients, and in a referral practice, the patients that also see a Cardiologist will have their lipids check by them. Since, we may not have that test in our file, they eliminated our quality incentive. One month they wanted us to bring in all our females of a certain age to bring their pap smears up-to-date. Well, most women resent such a focus, especially since they usually have a gynecologist that does their pelvic exam. Since our nurse practitioner died, we don’t do pelvic exams in our office. So we lose out on a significant financial incentive for a decrease in Quality of Care when there has been no decrease in QC. We tried to so some of that secretarial mapping for them one month, and after two afternoons of useless work, very few of our patients responded by getting the lab work or exam our HMO demanded.
Dr. Ruth: Since we are not involved in the HMO manipulation of care, are we talking about significant dollars?
Dr. Milton: At the last HMO meeting, I saw some of my colleagues that were reaping up to $15,000 in incentives per quarter for doing all that secretarial research for them.
Dr. Rosen: I think many doctors are not good business people and will have an employee available to do just that not realizing that the employee costs may exceed the incentive which in turn is not related to any discernable quality of care issues.
Dr. Dave: When will doctors cease being Pawns of the Medical Illiterate?
Dr. Milton: Not in our lifetime! They are too afraid of retribution. Abusive Peer Review by competing colleagues or Medicare Prosecution for using the wrong codes.
Dr. Rosen: That reminds me to warn all physicians to get out of Medicare and all government programs by October 2015 when the new ICD 10 codes will be implemented. Looking at the number of doctors prosecuted with the last change in codes, going from 16,000 to 64,000 in October 2015, almost any interpretation, whether ICD or CPT, could easily be interpreted as an error and subject to retribution, whether the Graveyard known as the National Data Bank or even a prison term. What a way to end one’s professional career.
Dr. Milton: The doctors that feel they are protected by being a hospital foundation employee will be very surprise. The hospital will be protected, even when using the highest paying codes. But they still will use Abusive Peer Review. Several were reference in this Newsletter.
The Staff Lounge Is Where Unfiltered Opinions Are Heard.
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Voices of Medicine: A Physician summarizes Obamacare in just one sentence.
Dr. Barbara Bellar
We are gifted with a health care plan we are forced to purchase and fined if we don’t; which purportedly covers at least 10 million more people without adding a single new Doctor; but provides for 16,000 new IRS agents; written by a committee whose chairman says he doesn’t understand it; passed by a Congress that hasn’t read it and signed by a President who smokes; with funding administered by a treasury chief who didn’t pay his taxes; for which we will be taxed for 4 years before any benefits take effect; by a government that has already bankrupted social security and Medicare; all to be overseen by a surgeon general who’s obese; and financed by a country that’s broke.
What on earth could possibly go wrong?
VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about
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Book Review: A Tale of Two Steve’s
By Rick Flinders, MD
Steve Jobs, by Walter Isaacson, Simon & Schuster, 656 pages.
Perhaps the first clue to how much Steve Jobs thought of himself is his choice of biographer: Walter Isaacson, the same man who wrote biographies of Albert Einstein and Benjamin Franklin. Did Jobs consider himself in the same league, innovatively and historically, as these two? Yes, he almost certainly did. Perhaps the ultimate measure of his grandiose audacity is that he was probably right.
Few individuals have altered and shaped the fabric of our daily lives more than Steve Jobs. We’re talking here of an impact on the scale of people like Thomas Edison and Henry Ford. Look around and you’ll see, within arm’s reach, products of his creation that literally touch everything we do. The laptop. The cell phone. How we listen to music. How we communicate.
Jobs didn’t do this alone. But as he stood at the convergence of information technology and the creative arts, during an historic moment as transformative as the industrial revolution, he more than any other gave expression to the products of information technology that have become embedded into our daily lives. Read more . . .
How did he do this? And who was the man who did it? The answers, as revealed in Abramson’s biography through hundreds of hours of interviews with the people who knew him, are predictably complicated.
Jobs had a ferocious, even obsessive, will that could drive him to the exclusion of everything else, including reality. Those who worked with him all speak familiarly of what came to be called “Steve’s reality distortion field.” Often if a fact or situation interfered with his vision, he simply wouldn’t acknowledge its existence. This became a double-edged sword. On the one hand it led him to achievements others in the industry considered “impossible,” such as wresting control of recorded music from Sony and repackaging it as iTunes. On the other, it allowed him to deny and virtually abandon his daughter born in 1978, curious behavior for a father who resented his own biological parents for putting him up for adoption at birth.
As with most genius, there comes idiosyncrasy. Jobs’ creations all bore the same signature characteristics. They were elegant, durable and extraordinarily functional. But he went beyond that. They had to be aesthetically pleasing inside the locked compartments that were never visible to consumers. Even the machinery with which they were manufactured had to be of a certain color and decor.
. . . He once defended his disdain of focus groups by saying they were irrelevant: “People don’t really know what they want until I show them.”
The mark of Jobs’ personality persists in all his creations. Every Apple product is a “closed system.” No hardware may be added. No screwdriver can take it apart. . .
To work for Jobs was a mixed blessing. At meetings he could rant, cry, berate and belittle employees publicly, sometimes all at once. His intensity was legendary. He would sometimes hold a person in an unnerving gaze, without blinking, for several minutes at a time. To employees he was often not merely rude or dismissive, but cruel. Curiously, he carried Yogananda’s Autobiography of a Yogi with him most of the time, and he reread the book once a year. It is said, by those who knew Yogananda, that he could enter a room and fill it with calm. It is also said, by those who knew Jobs, that he could enter a room and fill it with ego.
And yet, those who did work for Jobs are in almost unanimous agreement: “Without Steve we could never have risen to our best work, and would have never accomplished what we did.” For me, a baby boomer, the book is not just the story of a fascinating contemporary, but a fascinating story of our contemporary history.
My favorite parts are of the early Steve Jobs. While seniors in high school, Jobs and his wonk friend Steve Wozniak posted computer-generated banners all over campus one afternoon saying, “Remember: Tomorrow is Bring-Your-Pet-to-School Day.” The following day such a menagerie of diverse and squabbling creatures descended on the unsuspecting campus that classes were cancelled, students sent home, and Jobs and Wozniak were suspended.
The two became inseparable. As Jobs recalls, Wozniak was “the first guy I ever met who knew more electronics than me.” Their first collaboration was the Blue Box, a device that replicated the tones that routed signals on the entire AT&T network, and allowed users to make long-distance calls anywhere in the world for free. The two friends once called the Vatican from a phone booth. Wozniak pretended to be Henry Kissinger and asked to speak to the pope. What began as pranks, however, became the template for an enduring partnership. Wozniak was the gentle wizard, coming up with inventions he was happy to give away. Jobs would figure out how to make them into a user-friendly package, market them, and make millions.
Jobs attended Reed College in Portland. He dropped out during the first semester, but he remained there for the next 18 months, auditing courses in Japanese calligraphy and Zen meditation. It was there that he acquired the aesthetic style that shaped all his future creations. The multiple fonts that were part of the graphic interface for the very first Apple computers, for example, Jobs attributes directly to his studies and experiences in Portland. The fonts became standard in the industry.
I find an inherent irony in Jobs’ life and legacy. He was a Zen Buddhist, dedicated to the philosophy and practice of being fully focused in the ever-present moment of here and now. The irony is that he created a technology that virtually guarantees nearly constant distraction in the hands and ears and lives of an entire generation. The average 20-year-old checks his or her handheld device for new messages every 27 seconds. Watch a group of high school students at a table in Starbucks “engaged” in conversation, for example, and see how often their eyes and attention are diverted from the one who is speaking to the palms of their hands.
How many young people are attuned to the sounds of their immediate environs or the world around them? Compare this group to the number sealed off from the world by earphones, and carried by sound to anywhere but the here and now. I was recently blind-sided by a young cyclist who turned, not in front of my car, but into my car. As he bounced off my passenger side door and sped away, I noticed the signature white earplugs that rendered him oblivious to surrounding traffic and the rest of the world. . .
Here’s a guy who goes to Reed College, drops out, takes LSD, studies calligraphy, travels to India, practices Zen, and then returns to the Bay Area to found a company that revolutionizes the practical use of information technology and becomes the richest company in the world. Ultimate poster child of the sixties?
To Steve the genius, I say, “Kudos. You were a master at putting together ideas, art and technology in ways that invented the future. You were living proof of your own motto: The people who are crazy enough to think they can change the world are the ones who do.”
To Steve the jerk, I say, “Why’d you have to be so mean?”
Dr. Flinders, a hospitalist who teaches in the Santa Rosa Family Medicine Residency, serves on the SCMA Editorial Board.
Notis Brevis: My daughter found Steve’s confirmation record at Trinity Lutheran Church in Palo Alto. She emailed him. He replied that was about the time he lost his faith and became a Buddhist.
The Book Review Section Is an Insider’s View of What Doctors are Reading about.
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Hippocrates & His Kin: The fee-for-service model is not what broke the system
Grace Cleaves • The Forbes article describes this ironic paradigm: we needed our docs to be excellent clinicians and we trained them to do that. Now we need them to be business savvy change leaders. We didn't train them to do that. We wanted them to know how many bones were in our hands, not how to read a P&L. We ask a lot of our physicians, including urging the transition to embrace leading and entrepreneurship in their set of tools.
fee-for-service model is not what broke the system, it is just a
What broke the system was time and the economic downturn. A medical practice or a hospital etc is a business and should be run like one in order to survive. However, medical practitioners are not business people and cannot run a business.
Many practices were started in boom times when money was easily available and at low interest rates. HMO were dishing out money under the capitation model. The money was good.
But then the VC money dried up (HMO failures, New Century bankruptcy etc) and the insurers started reigning in those whose capitation balances had become unmanageable etc. There was a brief pause with Medicare Part D, but after a while the trend continued. Then came the economic downturn, and after 5+ years of it, medical practices etc are facing the same difficulties that are facing all other small businesses. There is no rational reason to think that medical practices are not small businesses.
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Meyers, MD, MBA
thrive, doctors need to practice Othercare. That means:
1. Leading change
2. Manage their practices efficiently and effectively
3. Adopting an innovative and entrepreneurial mindset
4. Using non-face-to face and alternative care delivery models using digital health technologies
5. Consolidating to take advantage of efficiencies of scale and the elimination of fee for service medicine
There is increasing pressure on medical schools to teach this stuff. Otherwise they are teaching their graduates to fight the last war with blanks in their rifles before sending them over the top.
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and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow
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The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports.
Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog.
The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government.
To read the rest of this column, please go to www.medicaltuesday.net/org.asp.
The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business.
The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels.
Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.
The Heartland Institute, www.heartland.org, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?.
The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Be sure to read the current lesson on Economic Education.
The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse."
The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter.
Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis.
The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section.
The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission was to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, and was used by some as a justification for the Obama plan, they have lost sight of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions. Supporting RINOs such as Romney or Christie will always do more harm than good.
The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today.
CATO. The Cato Institute (www.cato.org) was founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio, articles and books at www.cato.org/people/cannon.html.
The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.
The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]
The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, wartime allows the federal government to grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St. Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in wartime, we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com.
Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read ? Choose recent issues. The last ten years of Imprimis are archived.
John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information
Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .
PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com/ To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .
PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser’s view on today’s health care problem: In today’s proposals for sweeping changes in the field of medicine, the term “socialized medicine” is never used. Instead we hear demands for “universal,” “mandatory,” “singlepayer,” and/or “comprehensive” systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this “nationalized financing” or “nationalized health insurance.” In a more honest day, it was called socialized medicine.
Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."
David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.
Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, which would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.
Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD. To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.
The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.
AAPS California Chapter
is an unincorporated association made up of members. The Goal of
the AAPS California Chapter is to carry on the activities of the
Association of American Physicians and Surgeons (AAPS) on a
statewide basis. This is accomplished by having meetings and
providing communications that support the medical professional
needs and interests of independent physicians in private practice.
To join the AAPS California Chapter, all you need to do is join
national AAPS and be a physician licensed to practice in the State
of California. There is no additional cost or fee to be a member of
the AAPS California State Chapter.
Go to California Chapter Web Page . . .
Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"
PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.
Our motto, "omnia pro aegroto" means "all for the patient."
* * * * *
Words of Wisdom
Creativity has no precedents.
It is better to create than to cremate.
Too many people think they are being creative when they are just being different.
Human Creativity has had its high and low eras in history. The Renaissance was one of the highest eras because greater creative freedom and increased support for creative people came together. Amid all the problems of the modern world, the combination of these same conditions encourages creativity today. . . These include theaters for the dramatic and concert arts, museums, professional groups and schools. . .
Some Recent Postings
In The April Issue: (There were no MedTues NL in June or July)
Restoring Accountability in Medicine, Government and Society
The ECONOMIST | Jul 6th 2013 | From the print edition
A NEW employee once asked Marc Rich for advice on trading. He expected, perhaps, “Buy low, sell high”, or “Think long-term”. Or perhaps, given Mr Rich’s habit of going to the office at daybreak, “Up with the lark”. Instead, Mr Rich picked up a knife and ran a finger across the edge. “As a trader you often walk on the blade,” he said softly. “Be careful and don’t step off.”
Few walked it more skilfully than Mr Rich. Obsessively, he scanned the globe to see crises coming, wars brewing, shortages looming. He bought before anyone else did, and was first there when countries began to look round for oil or zinc or nickel. After the Korean war, as a mere junior trader at Philipp Brothers in New York, he created a market in mercury, which the army needed for batteries. The price soared. From the late 1960s, somehow anticipating the Arab oil-export embargo, he began to create a spot market for oil. Previously, all crude was tied up by the big companies in inelastic long-term contracts. Starting in Tunisia, Mr Rich began to buy and sell it for immediate delivery, like any other commodity. When the embargo bit after 1973 he was swimming in oil when the majors were struggling, and was able to sell it at a mark-up of as much as $14 a barrel. Some called that profiteering. Mr Rich called it a service charge. He could have demanded more, but that would have been “like taking candy from a baby”.
A free agent in this exhilarating new market, he went from strength to strength. Turning on his insistent, feline charm, he sought out buyers and sellers while his partner Pinky Green arranged shipping. It was a winning combination, forged at Philipp Brothers but soon outgrowing it. In 1974 the two of them, peeved that their bonuses were still so small, left to form Marc Rich + Co. The main office was in Zug in safe, secret Switzerland, no questions asked.
From there, with cat-like tread, Mr Rich found his way round any political or moral obstacle. He sold Soviet oil to apartheid South Africa, despite a UN embargo, and between 1979 and 1994 made profits of around $2 billion there. He sent Soviet and Venezuelan oil to Cuba in exchange for sugar, ignoring America’s ban on trade. He sold on the global market surplus Iranian oil that had flowed to Israel down a secret pipeline, and kept the arrangement going seamlessly despite the Iranian revolution of 1979, another embargo, and the American hostage crisis. The Iranians respected their contracts, he explained. They could not sell their oil, so he bought and sold it for them, using shell companies wherever necessary. Keeping well below the radar, as he always did, he was soon the world’s largest independent oil-trader, with a turnover in 1980 of $15 billion.
Then he stepped off the knife-blade. In 1980-81 he violated America’s domestic oil-price controls by re-labelling Texas crude from old fields as new-found, jacking up the price by as much as 400%. He made profits of $105m and shipped them abroad, avoiding taxes of $48m. Once federal prosecutors were after him for that, they charged him with 64 other crimes, including racketeering and “trading with the enemy”. In 1983 he fled to Switzerland with his family, having also tried to spirit away two trunks of subpoenaed business papers.
Thereafter he became a fugitive, a star of the FBI’s most-wanted list. He remained—until 1994, when he sold his stake and his company became the vast, tentacular Glencore—the world’s biggest trader of metals and minerals, while darting between Spain, Switzerland and Israel, a citizen of all three. In Marbella or St Moritz, beside a $9.5m swimming pool or among his Braques and Picassos, with a fortune estimated at $2.5 billion, he reconciled himself to exile. His father died in America; he had to say kaddish down the telephone. You cry a little, you move on. . .
In 2001 Bill Clinton pardoned him, his hand pushed by the Israeli prime minister, the king of Spain, an ex-head of Mossad and Mr Rich’s ex-wife Denise, who had given generously to the Clinton library and to Democratic campaigns. The president later regretted his action, calling it “terrible politics”. Mr Rich, oblivious to politics, would have called it good business.
On This Month in History - August
On August 2, 1939, Albert Einstein, a gentle man of peace, wrote a letter to President Franklin D Roosevelt to urge research on Atomic energy, which led to the development of the atom bomb, the ultimate weapon of destruction—or of progress. Except for the persecution by Nazis, Albert Einstein might never have come here. Some feel that this is a good day to remember that there is indeed—or has been—some guiding force which has favored our land. August 2 may be a good day to remember that.
On August 2, 1964, the North Vietnamese attacked a U. S. Destroyer in international waters of the Gulf of Tonkin. As a result, Congress, a few days later, adopted the Gulf of Tonkin Resolution which gave the President broad powers to use the armed forces without a declaration of war. This was followed by deeper U. S. involvement in Vietnam, where over many years the U. S. fought a bloody and ultimately futile war.
We have been urged to remember the Alamo and remember the Maine and remember Pearl Harbor. It may be well for us, on this date, August 2, to remember the Gulf of Tonkin. If we occasionally look back, perhaps we can also look ahead with much clearer vision.
After Leonard and Thelma Spinrad
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Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, any single payer initiative, Social Security was born for the benefit of the state and of a contemptuous disregard for people’s welfare.
We must also remember that ObamaCare has nothing to do with appropriate healthcare; it was similarly projected to gain loyalty by making American citizens dependent on the government and eliminating their choice and chance in improving their welfare or quality of healthcare. Socialists know that once people are enslaved, freedom seems too risky to pursue.