MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VII, No 17, Dec 9, 2008
In This Issue:
The Annual World Health Care Congress, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. The third year it was 50 percent, indicating open forums such as these are critically important. The 4th Annual World Health Congress was held April 22-24, 2007 in Washington, D.C. That year many of the world leaders in healthcare concluded that top down reforming of health care, whether by government or insurance carrier, is not and will not work. We have to get the physicians out of the trenches because reform will require physician involvement. The 5th Annual World Health Care Congress was held April 21-23, 2008 in Washington, D.C. Physicians were present on almost all the platforms and panels. This year it was the industry leaders that gave the most innovated mechanisms to bring health care spending under control. The solution to our health care problems is emerging at this ambitious congress. Plan to participate: The 6th Annual World Health Care Congress will be held April 14-16, 2009 in Washington, D.C. The 5th Annual World Health Care Congress – Europe 2009 will meet in Brussels, May 23-15, 2009. For more information, visit www.worldcongress.com. The future is occurring NOW.
To read our reports of the last Congress, please go to the archives at www.medicaltuesday.net/archives.asp and click on June 10, 2008 and July 15, 2008 Newsletters.
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There's an old saying that inside every 70-year-old is a 35-year-old wondering, "What happened?"
What happened is that countless days, nights, meetings, commutes and other unremarkable events went by, well, unremarked. They didn't make a lasting impression on the brain or they were overwritten by so many similar experiences that they are hard to retrieve. In short, they've been forgotten.
That's not necessarily a bad thing. Neuroscientists say forgetting is crucial to the efficient functioning of the mind, to learning, adapting and recalling more significant things.
"We focus so much on memory that forgetting has been maligned," says Gayatri Devi, a neuro-psychiatrist and memory expert in New York City. "But if you didn't forget, you'd recall all kinds of extraneous information from your life that would drown you in a sea of inefficiency."
That was what prompted Jill Price to contact the memory experts at the University of California at Irvine in 2000. As she wrote in a book published this summer, "The Woman Who Can't Forget," Ms. Price could recall in detail virtually every day since she was 14, but she was mentally exhausted and tormented by her memories. UC Irvine scientists are interviewing more than 200 people who say they have similar "autobiographical" memories, but so far have found only three more.
Memories of singular, significant events -- say, last week's historic election -- are generally easy to recall; people typically store them in long-term memory with many associations attached.
Memories of mundane, recurring events compete to be recalled, and scientists say the brain appears to be programmed to forget those that aren't important. Neuroimaging studies show that it's the brain's prefrontal cortex, the area of complex thought and executive planning, that sorts and retrieves such "like-kind" memories. Researchers at Stanford University's Memory Laboratory demonstrated last year that the more subjects forgot competing memories, the less work their cortexes had to do to recall a specific one. In short, forgetting frees up brain power for other tasks, says psychologist Anthony Wagner, the lab's director.
A real-world example, he says, is having to learn a new computer password every few months: As your brain suppresses the memory of the old password, it gets easier to summon the new one.
In fact, forgetting is a very active process, albeit subconscious, neuroscientists say. The mind is constantly evaluating, editing and sorting information, all at lightning speed. "Your brain is only taking a small amount in, and it's already erasing vast amounts that won't be needed again," Dr. Devi says.
Much that happens during the day doesn't make an impression at all because our attention is focused elsewhere. Take your daily commute, says Dr. Wagner: "A heck of a lot of stuff is landing on our retinas as we're driving down the road. But if you were focusing on the presentation you have to give, you didn't perceive it and it didn't get stored."
He notes that people face such a constant cognitive barrage that they frequently fail to attend to information that isn't essential at the time. "I have two 4½-year-olds and I'm already thinking, where did those first four years go?" Dr. Wagner says.
Numerous studies have shown that when people are asked to focus on one thing, they can fail to notice others - phenomenon called "change blindness." In one famous test, when viewers are asked to count how many times a basketball changes hands in a video, roughly half don't notice that a gorilla walks through the scene.
Conversely, people who have remarkable memories for, say, sports statistics or who-wore-what to parties paid attention at the time and attached significance to it, while it doesn't register on other people's radar screens at all.
Are memories for events you didn't focus on stored in your brain nevertheless -- like unwatched bank-surveillance tapes? That's an area of much debate. Some experts believe hypnosis can trigger long-buried associations. But so-called recovered memories are also susceptible to distortion.
"Memory consists of billions of puzzle pieces, and many of them look the same," Dr. Devi says. "Each time you retrieve a memory, you're reconstructing a puzzle very quickly and breaking it down again. Some of the pieces get put back in different places."
What if you want to remember more about each passing day? One simple method is to keep a journal. Writing down a few thoughts and events every day not only makes a tangible record, it also requires you to reflect. "You're elaborating on why they were meaningful, and you're laying down an additional memory trace," says neuroscientist James McGaugh at UC Irvine. Taking photographs and labeling them reinforce memories too.
But remember that forgetting can be very useful, says Dr. McGaugh: "If you used to go out with Bob and now you're married to Bill, you want to be able to say, 'I love you, Bill.' That's why forgetting is important."
Write to Melinda Beck at HealthJournal@wsj.com.
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2. In the News: Coverage With Limits Is Better Than No Coverage
What Tennessee Is Doing About Health Insurance
Three years ago, I realized something about health care. I've taken part in uncounted policy discussions about America's uninsured, both as governor of Tennessee since 2003 and before that as CEO of Nashville-based HealthAmerica Corp. Everyone regularly criticizes the unfairness of the system. But we don't make progress.
What I realized was this: Everyone proposing solutions or criticizing unfairness was doing so from the comfortable vantage point of having good health insurance. While we work to build a better system, wouldn't it also be responsible to find a way to get something -- not a perfect solution, not even a long-term solution -- into the hands of the more than 46 million uninsured Americans who don't share our good fortune?
Dottie Landry is one of those uninsured Americans. She lives in Nashville and is self-employed. She makes and sells jewelry. Over the years, she has been generally healthy but uninsured. In 2000 she got very sick -- from a tick bite -- and had to spend about $9,000 for medical care. She put most of it on her credit cards, which took years to pay off.
We all want to help Ms. Landry, but here's the problem: a comprehensive health-insurance policy for her costs about $5,000 a year, and someone has to pay that. That's a real number that won't go away with group purchasing or by beating up insurance companies. Ms. Landry can't afford that, and in a world of trillion-dollar deficits it's hard to see how the federal government can either.
We need a national health-insurance solution, but isn't it sensible in the meantime to make sure everyone has a basic health plan before we give a few more people a perfect but expensive one? Shouldn't we make sure everyone at least has a Chevy rather than providing a Cadillac to a few and letting the rest walk? We're trying that in Tennessee with CoverTN.
CoverTN, which began in 2006, is a health-insurance plan for those who are self-employed, or who work for small businesses that can't afford a traditional policy.
It is not free health care. Rather it is a limited plan with shared costs. In devising this plan, we didn't start out the usual way -- by defining what benefits we wanted -- but instead set how much we wanted to pay. And then we began a competitive-bidding process to see how much health care we could buy. We initially set the amount we would pay at an average of $150 a month, and split the responsibility for that premium three ways. The company would be responsible for $50, the individual for $50, and the state for the final $50.
The bidding was vigorous. It was ultimately won by BlueCross BlueShield of Tennessee with a benefit package that meets a great many -- not all -- of the real needs of the uninsured at a cost far below conventional plans.
At these premium levels -- less than half of what a conventional plan might cost -- the benefits are limited. But the benefit structure is also different than in a conventional plan. Most limited plans achieve their savings with high front-end deductibles, requiring a person to spend often thousands of dollars out-of-pocket before benefits kick in. But when we asked our customers -- uninsured Tennesseans -- what they actually wanted, we found that they were most interested in some help with the more common things; a doctor's visit, prescriptions, a short hospital stay.
CoverTN emphasizes covering these front-end costs. It features free checkups, free mammograms and $15 doctor visits without deductibles, for example. And it achieves its savings on the back end, with relatively low limits on hospital stays and an overall $25,000 benefit limit in any one year. It does not cover truly catastrophic events.
This makes medical sense. Good access to a doctor and a drugstore when you first have a problem can avoid a lot of cost and heartache later.
One thing that has been unexpected is the success of a generics-only prescription drug program. We needed to cover medications, but because of the high prices and aggressive marketing of branded prescription drugs, we were concerned that the costs would overwhelm the program. With some misgivings, we required our bidders to propose a largely generic prescription program. It's worked surprisingly well. Physicians have typically been able to select suitable medications for their patients, and patient satisfaction has been high and complaints few.
Having been badly burned by uncontrolled growth in costs in Tennessee's Medicaid program (TennCare once gobbled up a third of the state's budget), we proceeded cautiously with CoverTN and have been rewarded with good control of costs. This fall we added some benefits: The number of primary care visits doubled from six to 12, for example. Best of all, we added them without increasing rates. When did you last hear of a health-insurance plan whose annual update was a benefit improvement but no rate increase?
An obvious and valid criticism of health insurance such as this is what happens when a patient exceeds the benefit limits.
What we're finding is that even in health care, when people know that there are limits, they work to manage their costs. This year, as of the first nine months, only four people out of the more than 15,000 people covered had hit the maximum overall limit of $25,000, and only three had exceeded the separate in-patient hospital limits. A larger number, under 4%, hit the quarterly pharmacy limits during those first nine months.
Even those who go over the benefit limits get the significant advantage of being able to piggyback their personal expenditures on the contracts CoverTN has negotiated. By doing this, they often can cut their costs on uncovered health care in half.
Ms. Landry, to continue her story, has joined CoverTN and is very happy with it. About a year and a half ago, right after she joined, she had a bad dog bite that put her in the emergency room with several follow-up visits. The cost for this episode was about $4,000, and CoverTN paid for almost all of it.
The Chevy plans certainly have their critics, and I don't offer CoverTN as the perfect or ultimate answer, but it sure has worked for Ms. Landry and thousands of other Tennesseans.
Mr. Bredesen, a Democrat, is the governor of Tennessee.
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3. International News: Collectivist Farming is as bad for your health as Socialized Medicine
Among the past century's horrors, the Great Famine in Ukraine manages to stand out. First, for the scale of the mass starvation inflicted by Stalin on millions of people in Europe's agricultural breadbasket, and second, for how little the world knows about this genocide. A now-free Ukraine wants to change that and just marked the 75th anniversary of the 1932-33 "terror famine," or "Holodomor," says the Wall Street Journal.
Starting in the late 1920s, Stalin set out to collectivize and hobble the Soviet peasantry. His aim was to crush "the peasantry of the U.S.S.R. as a whole, and the Ukrainian nation," wrote Robert Conquest in his groundbreaking book, "The Harvest of Sorrow." The result:
· An estimated 14.5 million people starved to death in Ukraine, Russia and Belarus when farmland was collectivized and harvests requisitioned; yet, the submission of Ukraine to Moscow helped prolong the Soviet Union's life for another 60 years.
· The Stalinist regime and its ideological soul mates denied the famine at the time and later.
· Walter Duranty, the New York Times's longtime Moscow correspondent, was Stalin's chief apologist, sending false dispatches from Ukraine; he won a Pulitzer Prize.
· The left-leaning academy condemned Conquest and the late James Mace, the leading researcher of the famine, when their work appeared in the 1980s, and the Berlin Wall's collapse shamed some of the denialists.
The exception is the current Russian leadership, says the Journal. President Dmitry Medvedev accused Ukraine of seeking to achieve "opportunistic political goals" based on "manipulations and distortions, falsification of facts about the number of dead." As in Stalin's day, Ukraine's independent identity and nationhood stands in the way of a resurgent Russian imperium. By remembering the Holodomor, Ukrainians say: Never again.
Source: Editorial, "A European Genocide," Wall Street Journal, November 24, 2008; and Robert Conquest, "The Harvest of Sorrow," Oxford University Press, 1987.
For more on International Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=26
Socialized Medicare does not give timely access to health care, it only gives access to a waiting list.
Collectivist Farming does not give access to food, it only produces famine, hunger and death.
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4. Medicare: New coding system to cost $1.64 billion over 15 years. (See Voices of Medicine below)
Government regulators are expected soon to overhaul the aging coding system that doctors and hospitals use to bill insurers -- a switch that many in health care say is necessary, but that could initially cause headaches for consumers and their doctors.
Hospitals, insurance companies and many doctors say the planned coding system is necessary to keep up with the host of new medical developments that emerge every year. The new system, known as ICD-10, would sharply increase the number of codes used to define various ailments and procedures to 155,000, nearly 10 times as many codes as are currently in use. Today, for example, there's just one code -- 39.50 -- for angioplasty, a procedure used to widen blocked blood vessels; under the new system, medical practitioners can choose among 1,170 coded descriptions that pinpoint such factors as the location and the device involved for each patient.
Decoding the Codes
Doctors and hospitals may soon be required to use a new medical-coding system. Here are some pros and cons:
· The new codes can offer more detail on patients' conditions.
· Doctors complain that changing to the new system will eat up time and money.
· Hospitals could get higher payments for performing more-advanced surgeries.
· Consumers may see more billing errors as the new system rolls out.
The Centers for Medicare and Medicaid Services, or CMS, the federal agency charged with maintaining the medical codes, says the new system will allow doctors to include more details on patients' medical records. This could give a boost to efforts by government and industry to encourage the adoption of a nationwide electronic medical-information system. The coding changes also will make it easier to track outbreaks of new diseases, federal officials say.
Hospitals have been urging the coding-system upgrade for years, in part because the new codes make it easier to describe advanced surgeries and procedures that generally command higher reimbursement rates.
But many doctors in private practice are expected to have to scramble to adapt to the new system's greater complexity -- especially because regulators are aiming for the new system to be fully in place within three years. Many doctors and insurers are lobbying to extend that deadline to about five years or more, and some say the new codes are unnecessary.
"They are not simple changes. All of that is going to cost money" to buy and install new software and train physicians, coders and nurses, says Tom Felger, a family physician in South Bend, Ind. He worries that in the short run, the five doctors in his practice will end up spending more time on paperwork and less time with patients.
CMS estimates additional costs to the medical industry of adopting the new coding system of $1.64 billion over 15 years.
Some medical-industry officials also are concerned that consumers could see, at least initially, an increase in billing errors. That can lead, for example, to overcharging of patients, or an insurer denying payment for a claim because it was submitted with an incorrect code. Some officials also expect an increase in billing fraud and more delays in payments to doctors and consumers.
CMS says it expects implementation of the new system initially will boost by as much as 10% the number of claims returned because of coding errors. But a study by the Blue Cross and Blue Shield Association of insurers predicts billing errors are likely to rise between 10% and 25% in the first year. The group says extending to five years the deadline for implementing the changes could ease the problems.
"The [three-year] time frame proposed is unworkable in the real world," says Alissa Fox, vice president for legislative and regulatory policy at the Blue Cross and Blue Shield Association.
"Because of the complexity of the change, the provider could make the [billing] mistake or the payer could make the mistake. The patient is stuck in the middle," says Larrie Dawkins, chief compliance officer at Wake Forest University Health Sciences, a network of 800 physicians in Salem, N.C. He says claim rejections currently at medical practices typically run at a rate of 5% to 12%.
The U.S. adopted the current coding system, known as the International Classification of Diseases, about 30 years ago, based on a framework developed by the World Health Organization. Most of the world's developed countries have already modernized their versions. And while CMS has updated its codes regularly, the planned overhaul would represent the biggest expansion by far in the U.S. coding system.
CMS proposed the regulation for the new system in August, closed the public comment period on Oct. 21, and aims to publish the final rule before the end of the year, a CMS spokesman says.
The new system of 155,000 codes includes 68,000 codes describing diagnoses, up from 13,000 currently, and 87,000 codes for different medical procedures, compared with 3,000 in the current system. Hospitals use both types of codes, but physicians use only the diagnostic codes. For procedures, physicians rely on a separate system of nearly 9,200 codes from the American Medical Association that dates back to the 1960s.
CMS says the current system of numbered codes has run out of room to expand. That has led to some new treatments being grouped with unrelated diseases. For example, in the rapidly developing field of heart treatments and procedures, some codes are stuck in with eye treatments -- a section that still has spaces to add new numbers.
"The lack of space is a symptom of the fact that medical procedures are changing so quickly," says Karen Trudel, deputy director of the CMS's Office of E-health Standards and Services. CMS also oversees the Medicare federal insurance program for the elderly and disabled, which pays for about half of all procedures performed at hospitals.
George Arges, senior director at the American Hospital Association's health-data management group, says the new coding system could lead to higher payments for hospitals that perform more-advanced surgeries, among other benefits. He expects hospitals will see lower administrative costs because the new, more specific codes will require less back and forth with insurers to clarify what treatments were performed.
Robert Tennant, senior policy adviser at the Medical Group Management Association, a trade organization for medical group practices, says the new coding system will require that doctors get more medical details from each patient. Different insurers also might require different levels of specificity, he says.
For example, the current system has five codes describing a sprained ankle, but the new system has 45 codes, describing which part of the ankle joint was injured, whether it's the left or right ankle, and whether it's a first-time injury. "That's very complicated to a provider" to detail, Mr. Tennant says. If pressed for time, he says, a doctor might just check "unspecified" to describe an injury.
-Alicia Mundy contributed to this article.
Write to Jane Zhang at Jane.Zhang@wsj.com.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Physicians are probably the most highly trained, sophisticated workers in the world. After four years of college, physician training begins with four years of medical school and continues with four to eight years of postdoctoral work and supervised clinical experience. These newly trained physicians are then sent into the world at about age 34 to enter the work force as doctors who assist people with diseases and other health matters. As long as the patient pays the bills, they receive efficient care. Even when Blue Cross came along with expensive hospital coverage, the patient still paid the professional fees and kept expenses tight to the vest. If this arrangement had remained in effect without government intrusion, health care today would be about half of the present cost. It would be affordable to everyone.
The county hospitals did an excellent job of giving quality of care to the poor, usually with physicians donating their professional services. Most doctors I knew would plan to donate 8 to 10 hours a week to this charity. It was a good feeling for physicians and surgeons, and the patients we saw were deeply appreciative. Many told their families of the well-know doctors who took care of them in the county hospitals. All county hospitals had interns and residents to take care of these patients on an hour-to-hour basis with back up by the private doctor with whom they made the morning attending rounds.
There was no such item as uninsured. Everyone was covered by his or her hospital insurance or by the county welfare departments. Hospital insurance could be equated with high deductible insurance since the physicians' fees could be considered the deduction, although always affordable. For those that couldn't afford these fees, all the physicians I knew would provide them with free care. Physicians expected to give ten percent of their time to charity, either in their own offices or at the county hospital.
Then the cry came from unions, governments and socialists that it was demeaning to go to county hospitals as charity cases; these patients should be placed in the mainstream of health care. This resulted in the Kerr-Mills bill, the first significant intrusion into general health care. However, this didn't pacify the cry for Medicare which came along in 1965 and resulted in socialized medicine for everyone over 65 years of age. Then all the disabled were added. Then all the patients on kidney dialysis were added. Medicaid was also implemented to replace the Kerr-Mills aid for the poor.
These huge programs caused the largest inflation in health care costs the world has ever seen. Hospital construction boomed to take care of all the people that now wanted first-class inpatient services that in the past were happy with outpatient or county hospital services. The county patients never understood the economics of health care any better than their own. They padded down in the hospitals and were usually able to get a few extra days of free care. The daughter of one patient refused to take her mother home on December 23 stating that it was cruel to burden them with her care just before the holidays. It would be better if she could stay for an extra week until all the festivities were over and the guests had returned home. Why should anyone be concerned about an extra week of "mother" sitting at $2,000 a day? Isn't that what free care is all about?
Physicians have been criticized for the last three decades as being the cause of most of the excessive health care expenses. The whole managed care system was implemented by the government to control health care costs and much of it was directed against physicians. I remember managed care meetings where the managers were almost in tears saying, "Why can't you docs just put away your pen? That would save us a lot of money." I received a personal call from the CFO saying that he noticed I saw most of my heart and lung patients four times a year. Wouldn't three times a year be adequate? That will save us 25 percent of our cost of office calls. So the big push was less tests, less office visits, less consultations, less procedures, and less of anything that costs.
Now we have total reversal. With the emphases in the last several years to improved the highest level of health care in this country and make it an even higher quality, there has been a big push to make sure more tests, consultations and procedures are ordered. Lipids are requested to be checked more frequently, even if normal. Mammograms in later life are still requested yearly, even though many authorities recommend every second or even third year. Same for pap smears. At the medical grand rounds at the University of California at Davis, a visiting GI professor stated that far too many colonoscopies are done. He even suggested that unless there are risk factors, one procedure in the 60s was adequate and if a polyp was found, a second procedure in the late 60s or early 70s. The HMOs, presumably for PR purposes, are now recommending colon screenings starting at age 50. The gastroenterologists are being overwhelmed with the number of colonoscopies that are being requested, and their schedules are quite full. Colonoscopies are not an inexpensive procedure.
Bureaucrats feel that doctors are not adequately performing all these supposed procedures and, therefore, have concluded that physician care is inferior. This attitude will not really improve the quality of care but will make health care considerably more expensive. The impression of many of the physicians suggests that health care expenses will increase 25 to 30 percent with questionable improvement. With health care consuming close to 20 percent of GDP, these are significant cost increases.
Social Security would have remained viable if the age of retirement would have been the index for life expectancy. Then over the past 80 years, the retirement age would have been 75 and Social Security would have remained viable. There was no way that with retirement years now twenty years longer than in the 1930s, the worker could pay an extra twenty years for everybody to live off of everybody else. There is no Social Security depository - benefits are paid out of the Social Security taxes.
The same situation should hold for Medicare. To preserve Medicare, it should have been indexed with Social Security. At the current Social Security threshold, benefits would start at age 67. It should also be gradually indexed to age 75 according to current actuary life expectancy. Medicare would then have remained viable.
But Medicare will crash sooner if the current proposed Secretary of Health and Human Services gets his way and lowers the age for Medicare to 55. This will precipitate disaster since the current unfunded liability of Social Security, Medicare, Medicaid and SCHIPPS programs is estimated at ninety-nine trillion dollars. The president-elect's infusion of one trillion dollars in new taxes will have no effect on these liabilities. But they will keep the crowds pacified until the next elections. Rather like the Romans who kept the masses pacified by throwing the Christians to the lions.
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6. Medical Myths: Health Reform Plan - Improving Health or Limiting Access?
Plan Could Be Economic Disaster According to NCPA Economist Devon Herrick
The sweeping health reform plan proposed by Senate Finance Committee Chairman Max Baucus suffers from several expensive and fatal flaws, according to a National Center for Policy Analysis health economist.
NCPA Senior Fellow Devon Herrick called the Baucus proposal a "blueprint for economic disaster in health care coverage for Americans."
"The end result of Baucus' plan would destroy any choices that consumers have to select health coverage that meets their individual needs," said Herrick. "We would be stuck with a government-designed and regulated health plan that will drive up costs and limit access for too many consumers."
"Whenever these types of regulations are imposed at the state level, premiums have jumped two to three times the national average," said Herrick, a noted NCPA health economist. "Mandated coverage would force consumers to buy plans with benefits they may not want at prices they cannot afford."
The Baucus plan includes many of the same elements implemented in the Massachusetts mandated health plan, which Herrick said is now suffering from massive cost over-runs for the state and escalating premium costs for consumers." He added, "Many newly insured patients have been unable to find doctors willing to treat them under the new reimbursement levels."
The solution, said Herrick, is portable coverage that moves with workers from job to job, and that allows families to choose the level of benefits they need at a cost they can afford.
"The bottom line," said Herrick, "is that the Baucus plan will exacerbate current problems of skyrocketing costs and limited access while creating a huge burden for individual taxpayers and businesses. There is no such thing as free health care."
Herrick is a preeminent expert on 21st century medicine, including a variety of critical health care issues, such as health insurance and the uninsured, patient empowerment and trends in state health policy reform.
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Dr. Rosen: I had an interesting and challenging patient today.
Dr. Yancy: What was it a gallstone?
Dr. Edwards: Don't mind Yancy. Surgeons can't think of anything interesting unless they can cut.
Dr. Yancy: What's wrong with that? I'd operate on my mother if she needed it.
Dr. Rosen: I had a 70-year-old professional man who has a pulsation in each eye at 5 o'clock. Since, it is in both eyes at the same spot, I put the lesion in his optical cortex.
Dr. Ruth: Well, what did the MRI show?
Dr. Rosen: He declined. Actually, he was in for a GI problem, not the type that Yancy could operate on. The visual pulsation was just an incidental comment he made. He's had this for 15 years.
Dr. Milton: Sounds like an aneurysm in his brain to me. Don't you think it should be removed before it ruptures?
Dr. Rosen: That was my first impression. But since he's had it for so long, he thinks he will live longer with it in his head than with an operation gone wrong and half his body paralyzed.
Dr. Patricia: But wouldn't you like to know? Wouldn't HE like to know?
Dr. Kaleb: I don't think I would want to know if I was 70 and had it for 15 years. I'd just make sure my BP was normal.
Dr. Rosen: Actually he does have hypertension. But he keeps it well controlled - to the point that he gets light headed if he gets up to quickly.
Dr. Kaleb: So he's doing exactly what I would. Keep that BP low and keep the surgeons from cutting into his brain.
Dr. Sam: Milton might be correct. But it could also be an ugly A-V malformation and it wouldn't come out so smoothly at surgery. With a large defect in his brain post op, he would have some obvious deficits. Instead of a small pulsation, he might have half of his visual fields missing.
Dr. Patricia: Why don't you get an MRI and put his mind at ease?
Dr. Sam: You really want to give him something to worry about. That would be the last thing to put the mind at ease.
Dr. Edwards: What did his ophthalmologist think?
Dr. Rosen: Actually he also ran that by his ophthalmologist some time ago and he said he didn't see anything in the retina to explain the pulsation.
Dr. Ruth: Obviously not. It's in both visual fields so it has to be in the cortex of the brain.
Dr. Sam: There are neuro-ophthalmologists now. They would have clues. You could consider getting their opinion.
Dr. Edwards: There are two sides to that coin also. They would be much smoother into talking your patient into a craniotomy with greater confidence. The patient would have increasing difficulty in saying "no."
Dr. Rosen: My patient even mentioned that he had one knee arthroscopy. When the other knee went bad, he declined to go back to the orthopedist precisely because he wished he hadn't had the first one. But he saw no way of politely declining and he didn't want to put himself in such a situation again where someone smoother could talk him into surgery. He thought the brain was more crucial than the cruciate in his knee.
Dr. Edwards: I suspect when Mr Daschle gets national health care going and everybody's at war with everyone else in the health care field, who'd get dinged for not doing the highest quality of care even if it kills the patient.
Dr. Rosen: With the current crises, and Medicare and Social Security with a $99 trillion deficit, there's not enough money to even think of extending socialized medicine.
Dr. Edwards: But lack of logic has never deterred Congress from doing the illogical even though it is detrimental to your health or your life.
Dr. Rosen: I think I'll go back to my office before I get carried away about the Federal Government.
Dr. Edwards: Yes, our government is following the history of government oppression and slavery throughout the ages. Except we're doing it without a dictatorship. Without Congress being knowledgeable about history, we are destined to repeat the mistakes.
Dr. Rosen: We can be ignorant about history, but can we be ignorant about current events? Bastions of socialized medicine, like England and Sweden, are struggling to privatize medicine because their care is deteriorating so badly with state medicine after sixty or more years.
Dr. Edwards: So that means our Congress has a bull-headed irrational agenda that further restricts our freedom, which will take sixty or even a hundred years to reverse.
Dr. Rosen: And with that observation, I will really excuse myself.
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Increasing the number of diagnostic codes from 16,000 to 155,000 will not improve the quality of health care. It will only increase government intrusions into Medicare and the practice of medicine to the detriment of all concerned.
When the Relative Value Study assigned an RVS number to all medical procedures in 1964 and 1969, it was quite simple. In regards to clinical medicine, there was the new patient consultation (90220) and the regular office visit (90250) and a couple of smaller codes (90240), which were generally used for a nurse visit and one for a medical assistant visit (90230) for an injection or a BP recording, now obsolete with the readily available blood pressure devices.
The government and medical society executives and legal types, then in an effort to balance clinical medicine with surgery procedures, developed the Resource Based RVS (RBRVS) for greater flexibility. There were now five different types of office calls depending on how much evaluation transpired, such as how many problems the patient had, how many organ systems were reviewed and how complicated the medical issues were (99211, 99212, 99213, 99214, 99215 and others). This was a thinly disguised subterfuge with the old 90250, the normal internal medicine charge for office evaluation, between the 99214 and the 99215, which could be variously interpreted.
With the era of For Profit Health Maintenance Organizations (FP-HMOs), the reimbursements were reduced. Doctors frequently upgraded their codes. This was technically a crime. To police the process, the government intruded to inside the office, actually reviewed the charts and counted the number of entries and problems discussed and examined. They would review a series of charts and extrapolate that percentage to the whole practice. For example, if there was evidence of over coding in ten charts in a hundred examined, then extrapolating that to the entire practice, of say 1000 charts, would mean criminal activity in 100 patients. With several variations in each chart at $10,000 fine per line, the number of dollars could reach millions in a busy practice.
Some physicians didn't comprehend the government's intent and allowed their staff to the assign new codes. The doctors felt that they did the same amount of work on each visit as before, the charges were the same as before for the office visit and what could be wrong with that. One physician was arrested after his charts were reviewed, and he was prosecuted. After being told by Medicare that what he did was wrong, he apologized and said he would use whatever code Medicare wanted in the future. The Medicare prosecutor then handed the doctor a document to sign stating that he acknowledged his error and would refrain from doing that again. Not even legal counsel understood the government's intent until they saw their client handcuffed and led off to jail. This particular colleague in my community received a two-year sentence, and since he is now a felon, lost his license to practice, lost his home, and lost his wife. Since he no longer can practice medicine, his father's quarter million dollar investment in his medical education vaporized and he has to do ordinary labor. What a waste of resources.
The current attempt to increase the ICD 9 codes, which has one code for angioplasty, to 1,170 codes for angioplasty in the ICD 10, is a similar hostile move by Medicare. To see if a cardiologist used the correct code with the correct diagnosis and, therefore, the correct charge means that Medicare will have to hire another army of reviewers to review cardiac catheterization reports and make a judgment on whether the cardiologist committed a crime and should be prosecuted and subject to fines and incarcerations.
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"The Shield": Crime and Punishment, By James J. Murtagh, M.D.
Police Drama vividly portrays a lower circle of hell for a guilty conscience.
Warning: spoiler alert. If you have not seen the final episode of The Shield, do not read further. The episode contains a major plot twist which is discussed in this Op-Ed.
"Corruptio optimi pessima,"
Latin proverb for "corruption of the best is the worst of all."
It is fiendishly appropriate that the television police drama, The Shield, ended its series in 2008, exactly 700 years since Dante began writing the Inferno. The Shield, possibly more than any other series, demonstrates the most intense hell on earth, forcing its worst characters to kill the people and things they love best.
Exquisitely appropriate punishments are meted out to the guilty, with twisted, but appropriate, justice. There is no escape for the damned, spiraling into lower and deeper cycles of pain.
For seven years The Shield, like the Sopranos, and HBO's "The Wire", shows evil in all its seductive guises. Of the three series, the Shield was most shocking, even moving its audience to cheer for the central character, Vick Mackey, the macho corrupt police detective at his most murderous and torturing self. Even Mackey's murder of a fellow policeman evoked a morbid fascination. How much could one man get away with?
Mackey initially plans to get away Scott-free through a devil-deal to turn state's evidence and become a snitch himself. He claims he beat the system. Or has he?
Wrong! Fate reserves circles in hell for treacherous murderers even below simple murderers. Not being caught appears infinitely crueler than being fried by 2,400 volts in an electric chair.
For his immunity, Mackey betrays everyone and everything he cares about. Mackey is sentenced to life in a cubicle, cut off from anything or anyone he ever cared about. He is in a deep freeze as cold as great lake Cocytus Dante described at the bottom of the ninth circle of hell, reserved for the great traitors of all time.
Hell's best-kept secret is that we create it for ourselves. Mackey connived, threatened, hoodwinked and betrayed to get this cubicle. It is nothing but an existential nightmare.
Others also receive punishments befitting their great sins. Mackey's one-time sidekick, Shane Vendrell kills his own wife and child, then kills himself. But not before Vendrell realizes the enormity of his crimes and comes to true contrition.
In a subplot, a sixteen-year-old serial murderer is caught. A haunting reminder is made that this boy could have grown up to be Vic Mackey, and there is little moral difference between the boy murderer and the ex-police cop. Both operate on the same ethic.
Robert Frost wrote that torment by ice can be much more painful than by fire, metaphorically contrasting passionate torments with death by hatred. Mackey's fate is death by ice, frozen into a bland cubicle, with no hope of redemption.
What is the best way to punish a depraved guilty man? To punish him? Or just possibly, not punishing the guilty would be even worse pain.
To read the entire OpEd Review, go to www.healthcarecom.net/JM_TheShield.htm.
To read more of Dr. Murtagh's other reviews, go to www.healthcarecom.net/JM_Profile.htm.
To read more book reviews, go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
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The art of being sick is not the same as the art of getting well. Some cancer patients recover; some don't. But the ordeal of facing your mortality and feeling your frailty sharpens your perspective about life. You appreciate little things more ferociously. You grasp the mystical power of love. You feel the gravitational pull of faith. And you realize you have received a unique gift - a field of vision others don't have about the power of hope and the limits of fear; a firm set of convictions about what really matters and what does not. You also feel obliged to share these insights - the most important of which is this: There are things far worse than illness - for instance, soullessness. -Tony Snow in the Jewish World Review, 2005.
Who are the Losers in the HHS Secretary's Proposed Health Care Plan?
Among the explicit "losers," he includes: "Doctors and patients might resent any encroachment on their ability to choose certain treatments, even if they are expensive or ineffectual compared to alternatives. Some insurers might object to new rules that restrict their coverage decisions. And the health-care industry would have to reconsider its business plan (emphasis added)." That is to say, they can stay in business and deliver their services, but only as the government bureaucrats say they may. They no longer would be genuinely independent. -Tom Daschle, proposed Secretary of Health and Human Services.
What an ultimatum to Doctors and their Patients. Where did all this anger originate? With their approval rate of 12 percent or one-half that of the President, what is their basis for stance?
Will the Internet replace doctors?
Patients now frequently check out the doctor's diagnosis and treatment plans on the Internet. Sometimes they check their symptoms before the visit or phone call so as to appear knowledgeable about health issues. Recently a patient called and said that for the last 24 hours he was dizzy on getting up and felt better as soon as he lay down again. He also mentioned that he gets dizzy in bed if he turns too fast. Since he has hypertension and the pills were reduced because of low blood pressure from over treatment, I suggested he take his BP the next time he's dizzy on getting up to see if he's still over medicated. He had forgotten to do so. If he gets dizzy on turning his head too fast, I said that sounds more like vertigo and perhaps his wife could run to the corner drugstore and get some Antivert or Meclizine and take one to three tablets a day. With this new information, we should be able to diagnose his condition the next day in the office.
He stated that he had searched the Internet and thought it might be his back causing this. I tried to explain that I saw no correlation to the bones of his back. He stated he thought it was his spinal cord causing these symptoms. I told him I was unable to see a connection. I still thought the differential was between a postural effect on his blood pressure or his middle ear, which can cause vertigo. He agreed to try the recommended approach and come in the next day on Monday with the suggested data.
Looks like Tom Daschle may still find a place in his new government health plan for Doctors. He needs this information before he closes all the Medical Schools since he thinks all the medical facts are now on the web and are free to everyone.
To read more HHK, go to www.healthcarecom.net/hhkintro.htm.
To read more HMC, go to www.delmeyer.net/hmc2005.htm.
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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. 00,000 Lost Jobs to California. This month, read John R. Graham's article: A private insurer has come up with a solution to our fragmented coverage. UnitedHealth Group will offer people the option of renewing their health insurance if they lose their jobs, or retire early.
• 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.
• 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 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. This month, be sure to read Amy Menefee (of the Galen's) article published in the Cincinnati Enquirer. As Americans reflect on their blessings this Thanksgiving, will they count the U.S. health care system among them? Politicians, the media and probably most people would say no. But if we alter the question, directing it toward the individual and away from the system, the answer changes drastically. A startling majority of Americans - 77 percent - said the quality of their own health care was "excellent" or "good" in a recent study.
• Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC) and has recently joined the Heartland Institute. His Consumer Power Report, is a weekly report summarizing recent developments on consumer-directed health care in the media, legislative and regulatory arenas.
• The Heartland Institute, Joseph L Bast, President, www.heartland.org, publishes The Heartlander, their bimonthly membership newsletter. It features an opening essay by Joseph L. Bast, news about upcoming events, donor profiles, and reports on Heartland's current activities.
• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, 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.
• 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. The Independence Institute is proud to offer a first-of-its-kind course on the moral and philosophical case for free market capitalism: Free People, Free Markets: The Foundations of Liberty! See www.i2i.org/main/page.php?page_id=1.
• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month read BRADLEY DOUCET: This is certainly an interesting time to be a libertarian. The rise of the libertarian-leaning independent voter presages better times ahead. It will not happen overnight, but in the vigorous marketplace of ideas that is flourishing in the Internet age, the truth will eventually out.
• 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. Remember their slogan: A free and prosperous world through choice, markets and responsibility.
• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission 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, they have lost site of their mission and no longer are a freedom loving institution. Freedom of people doing what is in their best interest is diametrically the opposite of Socialism, people forced into doing what the state desires.
• 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, which we featured last month; or 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 and publications 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, war time allows the federal government 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 war time 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 DINESH D'SOUZA who is the author of several best selling books, including Illiberal Education, The End of Racism, What's So Great About America, and, most recently, What's So Great About Christianity. The last ten years of Imprimis are archived.
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Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words of Wisdom
Rome remained great as long as she had enemies who forced her to unity, vision and heroism. When she had overcome all her enemies, she flourished for a moment and then began to die. -Will Durant, Caesar and Christ.
We live in the present, we dream of the future and we learn eternal truths from the past. -Madame Chiang Kai-shek.
You can't hold a man down without staying down with him. -Booker T. Washington
Some Recent Postings
A Time For Freedom, by Lynne Cheney www.delmeyer.net/bkrev_ATimeForFreedom.htm
We The People – The Story of Our Constitution, by Lynne Cheney www.delmeyer.net/bkrev_WeThePeople.htm
Mieczyslaw Rakowski, a Polish communist journalist and politician, died on November 8th, aged 81
CLUNKY cogs in the propaganda machine, communist journalists in eastern Europe were a dreary and dutiful lot. Mieczyslaw Rakowski was different. Polityka, the magazine he edited for 24 years, was the most readable official publication in the Soviet block: cogent, insightful, sometimes irreverent.
To foreigners reporting on the long slow death of the Soviet empire, Mr Rakowski was still more interesting in person, giving candid and waspish assessments of the communist regime's political, economic and personal shortcomings. He was amusing and friendly company, at a time when congeniality was as scarce in the east as toilet paper or matches. Unlike most senior communists, he was not pompous, bullying or hidebound: you could easily believe that he was just another human being, not a defender of a system based on lies and mass murder.
But unlike some, he did not leave the party, either then or after martial law was imposed in 1981. With scores killed and thousands jailed, Mr Rakowski became the right-hand man of the country's new military leader, General Wojciech Jaruzelski. He was ambiguous about whether he still truly believed in a democratic form of communism; Leszek Kolakowski, the exiled philosopher, rightly described that as "fried snowballs". Mr Rakowski preferred to argue that communism protected Poland from the Soviet Union, whereas full-scale opposition would be futile. The anti-communist fighters had died in the forests; the pre-war government, in exile in London, was a husk; the Catholic church was a reactionary force. If history had placed Poland in the communist camp, then hope lay only in being its happiest barracks.
Mr Rakowski's great ambition was to lead the communist party. He eventually became first secretary (as the job was called), but he was last as well as first, acting as the party's undertaker in 1989 after the round-table talks paved the way for freedom and true independence. Usually celebrated as an unalloyed triumph, that transfer of power had its drawbacks. Privatisation, launched by Mr Rakowski in the dying years of communism, had allowed influential insiders to start turning power into money to safeguard their positions. Dodgy foreign trade outfits, linked with military intelligence, flourished. Party funds that Mr Rakowski had shipped out of the country returned (via a KGB courier) to launch a new post-communist party.
Mr Rakowski's career fizzled out, fittingly, in an abortive bid for the Polish senate in 2005. His successful opponent was Radek Sikorski, now foreign minister, who had fled Poland as a political refugee from the martial law that Mr Rakowski so steadfastly defended.
On This Date in History - December 9
On this date in 1608, John Milton was born in London. This great British poet was the author of the lines: "Peace hath her victories, no less renown than war," and "Give me the liberty to know, to utter, and to argue freely according to conscience, above all liberties."
On this date in 1621, the first sermon was delivered in New England at Plymouth, MA, on "The Sin and Danger of Self-Love."
On this date in 1793, Noah Webster established New York City's first daily newspaper, The American Minerva. Newspapers come and go, but the news and media's delivery of it never stops.
On this date in 1884, Levant Richardson received the patent of his invention of ball-bearing roller skates. And skating, like news, just keeps rolling along.
After Leonard and Thelma Spinrad
MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks
funding for a movie exposing the truth about socialized medicine. Clements is
the former publisher of "American Venture" magazine who made news in
2005 for a property rights project against eminent domain called the "Lost
For more information visit www.sickandsickermovie.com or email firstname.lastname@example.org.